社区应用抗精神病药长效针剂治疗精神分裂症专家共识

doi:10.12114/j.issn.1007-9572.2022.0537

摘要/Abstract

摘要： 精神分裂症是一种慢性、高复发性和高致残性的精神病性障碍，提高患者治疗依从性、预防复发是精神分裂症治疗的关键，也是决定患者预后和社会功能改善程度的核心因素。抗精神病药长效针剂（简称长效针剂）作为精神分裂症治疗、预防复发的重要手段，被国内外指南/共识推荐为精神分裂症全病程治疗的方式之一。同时，社区作为精神分裂症康复的重要环境场所，近年来陆续开展了一系列社区管理模式的探索。目前，国内多个管理政策及文件强调在社区精神分裂症管理中应用长效针剂，但是社区医生对长效针剂的知识和应用技能不足，从一定程度上影响了长效针剂在社区的应用，成为患者全面康复的瓶颈之一。在中华医学会精神医学分会精神分裂症协作组的组织下，联合中华医学会全科医学分会，由13位精神科及全科医学专家组成本共识专家组，基于循证医学证据、国内外指南与专家共识、专家经验、我国社区的特征，解决社区长效针剂使用中面临的医学相关问题，以期提高精神分裂症患者用药依从性，改善患者预后。

关键词: 精神分裂症, 抗精神病药, 抗精神病药长效针剂, 社区卫生服务

Abstract:

Schizophrenia is a chronic, recurrent and disabling psychotic disorder. Enhancing patient adherence and preventing recurrence are the key factors of treating schizophrenia, and the core determinants of prognosis and social functional recovery of these patients. Recommended by guidelines/consensuses as one treatment for schizophrenia, long-acting injectable (LAI) antipsychotics have been an important intervention for treating schizophrenia and for preventing its recurrence. At the same time, as community settings are important sites for the rehabilitation of schizophrenia, considerable efforts have been made to explore models of community-based management of schizophrenia. Currently, the use of LAI antipsychotics in community-based management of schizophrenia has been highlighted in multiple policies and documents of China, but its application is negatively influenced partially by community physicians' insufficient understanding and application skills regarding LAI antipsychotics, which has become a bottleneck that hinders the comprehensive rehabilitation of schizophrenics. In view of this, a consensus was developed based on clinical evidence, previous guidelines and consensuses, expert individual practice and features of community settings in China, by a group of 13 experts, including psychiatrists from the Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry, and general medicine experts from the Chinese Society of General Practice. This consensus will significantly contribute to the solving of problems in the use of LAI antipsychotics for community-based management of schizophrenia, and the improvement of patient adherence and prognosis.

Key words: Schizophrenia, Antipsychoric agents, Long-acting injectable, Community health services

中华医学会精神医学分会精神分裂症协作组,中华医学会全科医学分会. 社区应用抗精神病药长效针剂治疗精神分裂症专家共识[J]. 中国全科医学, 2022, 25(29): 3587-3602. DOI: 10.12114/j.issn.1007-9572.2022.0537.
Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry,Chinese Society of General Practice. Expert Consensus on Long-acting Injectable Antipsychotic in the Treatment of Schizophrenia in Community[J]. Chinese General Practice, 2022, 25(29): 3587-3602. DOI: 10.12114/j.issn.1007-9572.2022.0537.

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比例	76%	24%

推荐强度	证据级别（级）	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究（可信区间窄）
	1c	全或无病案研究（未治疗前所有患者全部死亡或部分死亡，治疗后仅部分患者死亡或全部存活）
B	2a	同质队列研究的系统综述
	2b	单个队列研究（包括低质量随机对照研究，如随访率<80%）
	2c	结局性研究：生态学研究
	3a	同质病例-对照研究的系统综述
	3b	单个病例-对照研究
C	4	病例系列报告和低质量的队列、病例-对照研究
D	5	没有严格评价的专家意见或完全基于生理学、基础研究

推荐强度	证据级别（级）	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究（可信区间窄）
	1c	全或无病案研究（未治疗前所有患者全部死亡或部分死亡，治疗后仅部分患者死亡或全部存活）
B	2a	同质队列研究的系统综述
	2b	单个队列研究（包括低质量随机对照研究，如随访率<80%）
	2c	结局性研究：生态学研究
	3a	同质病例-对照研究的系统综述
	3b	单个病例-对照研究
C	4	病例系列报告和低质量的队列、病例-对照研究
D	5	没有严格评价的专家意见或完全基于生理学、基础研究

项目	氟哌啶醇癸酸酯	氟奋乃静癸酸酯
适应证（中国）	精神病的维持治疗	用于急、慢性精神分裂症；对单纯型和慢性精神分裂症的情感淡漠和行为退缩症状有振奋作用；也适用于拒绝服药者及需长期用药维持治疗者
注射部位	肌肉注射	肌肉注射
起始剂量	50.0 mg	12.5~25.0 mg
维持剂量	50.0~100.0 mg；300.0 mg^a	12.5~100.0 mg
注射频率	4周1次	说明书中未明确规定
初始治疗是否需补充口服药^b	否	否
注射液重装配置^c	是	是
冷藏储存^d	否	否
注射后留观^e	否	否

项目	氟哌啶醇癸酸酯	氟奋乃静癸酸酯
适应证（中国）	精神病的维持治疗	用于急、慢性精神分裂症；对单纯型和慢性精神分裂症的情感淡漠和行为退缩症状有振奋作用；也适用于拒绝服药者及需长期用药维持治疗者
注射部位	肌肉注射	肌肉注射
起始剂量	50.0 mg	12.5~25.0 mg
维持剂量	50.0~100.0 mg；300.0 mg^a	12.5~100.0 mg
注射频率	4周1次	说明书中未明确规定
初始治疗是否需补充口服药^b	否	否
注射液重装配置^c	是	是
冷藏储存^d	否	否
注射后留观^e	否	否

项目	RLAI	PP1M	PP3M
适应证（中国）	急性/慢性精神分裂症，其他精神病性状态明显的阳性阴性症状。与精神分裂症有关的情感症状	精神分裂症的急性期和维持期	接受PP1M充分治疗至少4个月的精神分裂症患者
注射部位	三角肌/臀肌	三角肌（前2针）/臀肌	三角肌/臀肌
起始剂量	25.0 mg	第1针：150.0 mg eq^a；第2针：100 mg eq	最后1针PP1M剂量的3.5倍
维持剂量	25.0 mg（可上调，最高不超过50 mg）	75 mg eq（25~150 mg eq调整）	175~525 mg eq
注射频率	2周1次	1次/月（第2针与第1针间隔1周）	3个月1次
起始治疗是否需补充口服药^b	否	否	否
注射液重装配置^c	是	否	否
冷藏储存^d	是	否	否
注射后留观^e	否	否	否