Autoři: Tomáš Kašpárek, Libor Ustohal
Garant: Libor Ustohal
Oponent: Pavel Mohr
Vysvětlivky:
ovál - nadpis
kosočtverec - výběr z více variant
přerušovaná čára - diagram pokračuje na další straně
Závěrečný komentář
Léčba akutní epizody schizofrenie často vyžaduje intenzivní farmakoterapii, která je klíčovým prvkem této fáze léčby. Je prokázáno, že léčba antipsychotiky u pacientů se schizofrenií působí jako prevence mortality z jakékoli příčiny, z důvodu suicidia a dokonce i z kardiovaskulárních příčin. Jako nejúčinnější se z tohoto pohledu jeví LAI AP II. generace a klozapin (Taipale et al., 2020; Correll et al., 2022). Vedle farmakoterapie je však zásadní již od začátku nemoci zahájit psychosociální rehabilitaci, práci na náhledu nemoci a adherenci; práce s rodinami pacientů v tomto smyslu má velký význam pro dlouhodobý průběh nemoci. Současně jsou vhodné aktivizační přístupy formou různých metod ergoterapie, nácvik sociálních dovedností i specifické psychoterapeutické přístupy zaměřené na zvládání příznaků. Akutní léčba má být plánována s ohledem na specifika jednotlivých pacientů jak z pohledu individuální účinnosti, citlivosti vůči nežádoucím účinkům a komorbidity, tak z pohledu potřeb následné léčby v konkrétním prostředí pacienta, jeho funkční kapacity a sociálního zázemí. Přestože je většinou nutná hospitalizace pacienta, je potřeba pracovat na zachování schopnosti samostatného života v komunitě, a pokud je to možné, využívat alternativy akutní hospitalizace (krizová lůžka, denní stacionáře, asertivní komunitní týmy), či hospitalizace v rámci akutních lůžek všeobecných nemocnic.
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Datum zveřejnění: 29.6.2024