{"id":2241,"date":"2020-01-14T13:43:51","date_gmt":"2020-01-14T13:43:51","guid":{"rendered":"https:\/\/schizofrenia.com\/verejnost\/?page_id=2241"},"modified":"2022-11-30T17:09:33","modified_gmt":"2022-11-30T16:09:33","slug":"manazment-schizofrenie","status":"publish","type":"page","link":"https:\/\/schizofrenia.com\/verejnost\/manazment-schizofrenie\/","title":{"rendered":"Mana\u017ement schizofr\u00e9nie"},"content":{"rendered":"\n
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Ako schizofr\u00e9nia naru\u0161\u00ed fungovanie?<\/h1>

Aby bolo mo\u017en\u00e9 u \u013eud\u00ed so schizofr\u00e9niou zlep\u0161i\u0165 celkov\u00e9 fungovanie, je potrebn\u00e9 sa zamera\u0165 na individualizovan\u00e9 klinick\u00e9 vy\u0161etrenie a lie\u010dbu negat\u00edvnych a kognit\u00edvnych sympt\u00f3mov.<\/p><\/a>

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Kognit\u00edvne poruchy patria medzi z\u00e1kladn\u00e9 charakteristiky schizofr\u00e9nie a uk\u00e1zalo sa, \u017ee z\u00e1sadne ovplyv\u0148uj\u00fa fungovanie jedinca.1<\/sup> Celkov\u00e9 fungovanie \u00fazko s\u00favis\u00ed s kvalitou \u017eivota. Funk\u010dn\u00e9 zhor\u0161enie pri schizofr\u00e9nii je z ve\u013ekej \u010dasti sp\u00f4soben\u00e9 negat\u00edvnymi a kognit\u00edvnymi sympt\u00f3mami, ktor\u00e9 m\u00f4\u017eu nar\u00fa\u0161a\u0165 soci\u00e1lne fungovanie, pracovn\u00fa pam\u00e4\u0165 a v\u00fdkonn\u00e9 funkcie. Je d\u00f4le\u017eit\u00e9, aby boli modern\u00e9 liekov\u00e9 re\u017eimy zameran\u00e9 aj na t\u00fato z\u00e1sadn\u00fa nepokryt\u00fa potrebu. Aj napriek mno\u017estvu \u00fadajov, ktor\u00e9 sved\u010dia v prospech pr\u00ednosu postupov zlep\u0161uj\u00facich kognit\u00edvne funkcie pri schizofr\u00e9nii, zost\u00e1va e\u0161te mno\u017estvo nezodpovedan\u00fdch ot\u00e1zok. V\u00fdskum sa zameriava predov\u0161etk\u00fdm na h\u013eadanie potenci\u00e1lnych faktorov, pod\u013ea ktor\u00fdch by bolo mo\u017en\u00e9 vopred predpoveda\u0165 \u00fa\u010dinnos\u0165 rehabilit\u00e1cie kognit\u00edvnych funkci\u00ed, preto\u017ee \u00fa\u010dinnos\u0165 lie\u010dby z ve\u013ekej \u010dasti z\u00e1vis\u00ed od vhodn\u00e9ho v\u00fdberu jedincov pod\u013ea z\u00e1va\u017enosti ochorenia a met\u00f3d lie\u010dby.2<\/sup><\/p><\/div><\/div>\n\n\n\n

Existuje aj \u010fal\u0161\u00ed cie\u013e lie\u010dby schizofr\u00e9nie, o ktorom sa hovor\u00ed menej. Zach\u00e1dza \u010falej ako len oby\u010dajn\u00e1 snaha o zn\u00ed\u017eenie frekvencie psychotick\u00fdch epiz\u00f3d a \u010dasto sa na\u0148 lie\u010dba nezameriava tak, ako na pozit\u00edvne sympt\u00f3my: je n\u00edm fungovanie jedinca.1<\/sup> Zlep\u0161enie funk\u010dnej kapacity jedinca ovplyvn\u00ed kvalitu jeho \u017eivota, ktor\u00e1 je nakoniec rovnako v\u00fdznamn\u00e1 ako lie\u010dba pozit\u00edvnych sympt\u00f3mov. Pr\u00edstup k lie\u010dbe je viacfaktorov\u00fd a obvykle zah\u0155\u0148a: pod\u00e1vanie psychofarm\u00e1k, psychologick\u00e9 z\u00e1sahy a pomoc s b\u00fdvan\u00edm a finan\u010dn\u00fdm zaisten\u00edm.3<\/sup>

\u00daplne z\u00e1sadn\u00fd je individu\u00e1lny lie\u010debn\u00fd pl\u00e1n (obr. 1). Na dodr\u017eiavanie lie\u010dby, jej \u00fa\u010dinnos\u0165 a kontinuitu starostlivosti s\u00fa potrebn\u00e9 pravideln\u00e9 kontroly jedinca, zhodnotenie dosiahnut\u00e9ho klinick\u00e9ho pokroku a pos\u00fadenie potrebn\u00fdch zmien re\u017eimu lie\u010dby lie\u010dby.4<\/sup>

K dispoz\u00edcii je nieko\u013eko mo\u017enost\u00ed lie\u010dby, ktor\u00e9 sa vyu\u017e\u00edvaj\u00fa v z\u00e1vislosti od pr\u00edpadu a z\u00e1va\u017enosti ochorenia.<\/p><\/div><\/div>\n\n\n\n

Ak\u00fatne psychotick\u00e9 epiz\u00f3dy
Pri ak\u00fatnej psychotickej epiz\u00f3de je najd\u00f4le\u017eitej\u0161ie zmierni\u0165 pozit\u00edvne sympt\u00f3my. V t\u00fdchto pr\u00edpadoch je vo\u013ebou \u010d\u00edslo jedna adekv\u00e1tna farmakoterapia a pos\u00fadenie funkcieschopnosti. Z\u00e1sadn\u00e9 je vybra\u0165 lieky, ktor\u00e9 nebud\u00fa ma\u0165 na pacienta tlmiace (sedat\u00edvne) \u00fa\u010dinky alebo neznesite\u013en\u00e9 ved\u013eaj\u0161ie \u00fa\u010dinky, ktor\u00e9 by mohli by\u0165 nepriazniv\u00fdm \u201eiatrog\u00e9nnym\u201c (lie\u010dbou navoden\u00fdm) faktorom ovplyv\u0148uj\u00facim funkcieschopnos\u0165. Je bezpe\u010dnej\u0161ie dosiahnu\u0165 sed\u00e1ciu pomocou benzodiazep\u00ednov pod\u00e1van\u00fdch v najni\u017e\u0161ej \u00fa\u010dinnej d\u00e1vke, ne\u017e antipsychotikami. V\u00fdber silno sedat\u00edvneho antipsychotika v tomto \u0161t\u00e1diu m\u00f4\u017ee br\u00e1ni\u0165 neskor\u0161iemu prepusteniu z nemocnice.<\/p>

Chronick\u00e9 psychotick\u00e9 epiz\u00f3dy
Pozit\u00edvne sympt\u00f3my sa pri v\u0161etk\u00fdch diagn\u00f3zach lie\u010dia podobne, aj ke\u010f sa pou\u017e\u00edvaj\u00fa in\u00e9 d\u00e1vky, re\u017eimy a d\u013a\u017eka lie\u010dby. Ak v\u0161ak nie s\u00fa pozit\u00edvne sympt\u00f3my tak\u00e9 \u010dast\u00e9 alebo ak nie s\u00fa pr\u00edtomn\u00e9 v\u00f4bec a v klinickom obraze preva\u017euj\u00fa negat\u00edvne a kognit\u00edvne sympt\u00f3my, je tu priestor pre in\u00fd druh lie\u010dby. Pri miernej alebo stredne z\u00e1va\u017enej depresii a \u00fazkosti je napr\u00edklad ako lie\u010dba prvej vo\u013eby odpor\u00fa\u010dan\u00e1 kognit\u00edvno-behavior\u00e1lna terapia.6<\/sup> V tak\u00fdch pr\u00edpadoch sa tie\u017e ve\u013emi odpor\u00fa\u010da \u00faprava \u017eivotn\u00e9ho \u0161t\u00fdlu a pravideln\u00e1 fyzick\u00e1 z\u00e1ta\u017e, preto\u017ee bolo preuk\u00e1zan\u00e9, \u017ee upravuj\u00fa funkcie mozgu, zlep\u0161uj\u00fa pam\u00e4\u0165, schopnos\u0165 robi\u0165 viac \u00faloh naraz a schopnos\u0165 pl\u00e1nova\u0165, navodzuj\u00fa obnovu mozgov\u00fdch buniek a d\u013a\u017eku s\u00fastredenia.7<\/sup> A kone\u010dne s\u00fa pre udr\u017eanie remisie z\u00e1sadn\u00e9 finan\u010dn\u00e1 podpora a naplnenie kari\u00e9rnych cie\u013eov.<\/p><\/div><\/div><\/div>\n\n\n\n

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\"\"\"\"<\/a><\/div>

Obr. 1: Zlep\u0161enie fungovania pri schizofr\u00e9nii<\/p><\/div><\/div>\n\n\n\n

Ak je potrebn\u00e9 zlep\u0161i\u0165 funkcieschopnos\u0165, je z\u00e1kladn\u00fdm bodom, ktor\u00e9 je nutn\u00e9 zv\u00e1\u017ei\u0165, aj lie\u010dba negat\u00edvnych sympt\u00f3mov<\/a> (obr. 1).3<\/sup> Napriek tomu, \u017ee negat\u00edvne sympt\u00f3my postihuj\u00fa a\u017e 26 % pacientov so schizofr\u00e9niou a a\u017e 58 % ambulantn\u00fdch pacientov so schizofr\u00e9niou, hor\u0161ie reaguj\u00fa na s\u00fa\u010dasn\u00e9 lieky ako pozit\u00edvne sympt\u00f3my.9<\/sup> \u00da\u010dinnos\u0165 na negat\u00edvne sympt\u00f3my navy\u0161e preuk\u00e1zalo len nieko\u013eko antipsychot\u00edk.10<\/sup> Z tohto d\u00f4vodu zost\u00e1va nedostatok \u00fa\u010dinn\u00fdch liekov na lie\u010dbu negat\u00edvnych sympt\u00f3mov v\u00fdznamnou nesplnenou potrebou, predov\u0161etk\u00fdm pokia\u013e zv\u00e1\u017eime v\u00fdznam t\u00fdchto pr\u00edznakov na v\u00fdsledky dosahovan\u00e9 u pacientov.9<\/sup> Preto je \u00faplne z\u00e1sadn\u00e9 negat\u00edvne sympt\u00f3my rozpozna\u0165, pochopi\u0165 a r\u00fdchlo rie\u0161i\u0165, preto\u017ee v\u010dasn\u00fd z\u00e1sah m\u00f4\u017ee v\u00fdrazne ovplyvni\u0165 celkov\u00e9 fungovanie a n\u00e1sledne aj kvalitu \u017eivota.8<\/sup>

Okrem negat\u00edvnych sympt\u00f3mov je tu \u010fal\u0161ia kateg\u00f3ria pr\u00edznakov, na ktor\u00e9 schv\u00e1len\u00e9 lieky necielia: kognit\u00edvne sympt\u00f3my (obr. 1). Aj tieto pr\u00edznaky s\u00favisia s celkovou funkcieschopnos\u0165ou a zost\u00e1vaj\u00fa nenaplnenou medic\u00ednskou potrebou.11, 12<\/sup> Kognit\u00edvne pr\u00edznaky nar\u00fa\u0161aj\u00fa v\u00fdkonn\u00e9 funkcie, predov\u0161etk\u00fdm rozhodovanie a spracov\u00e1vanie inform\u00e1ci\u00ed, ved\u00fa k nedostato\u010dnej pozornosti a zhor\u0161eniu pracovnej pam\u00e4ti.13<\/sup> Tieto pr\u00edznaky maj\u00fa so zrejmou pravdepodobnos\u0165ou dosah na kvalitu \u017eivota a ka\u017edodenn\u00e9 fungovania pacienta. V\u00fdskum kognit\u00edvnych sympt\u00f3mov v posledn\u00fdch desa\u0165ro\u010diach zna\u010dne pokro\u010dil. Modern\u00e9 lieky a re\u017eimy v\u0161ak st\u00e1le ved\u00fa m\u00e1rny boj pri dosahovan\u00ed v\u00fdrazn\u00e9ho zlep\u0161enia tejto kateg\u00f3rie pr\u00edznakov. \u00daspe\u0161n\u00e9 v\u00fdsledky pilotn\u00fdch \u0161t\u00fadi\u00ed zameran\u00fdch na kognit\u00edvne pr\u00edznaky neboli potvrden\u00e9 vo ve\u013ek\u00fdch \u0161t\u00fadi\u00e1ch. To potvrdzuje, \u017ee st\u00e1le je nutn\u00fd rozsiahly v\u00fdskum zameran\u00fd na t\u00fato problematiku.14<\/sup>

Hlavn\u00fdm cie\u013eom dne\u0161n\u00fdch liekov\u00fdch re\u017eimov je zlep\u0161i\u0165 celkov\u00e9 fungovanie. Doposia\u013e bola v\u00e4\u010d\u0161ina klinick\u00fdch \u00faspechov dosiahnut\u00e1 vyrie\u0161en\u00edm pozit\u00edvnych sympt\u00f3mov. Modern\u00e9 terapeutick\u00e9 mo\u017enosti by sa mali zameriava\u0165 aj na negat\u00edvne a kognit\u00edvne sympt\u00f3my a mali by by\u0165 \u010dasto a pravidelne prehodnocovan\u00e9 a upravovan\u00e9 pod\u013ea individu\u00e1lnych potrieb a preferenci\u00ed.15<\/sup> \u00daspe\u0161n\u00fd antipsychotick\u00fd re\u017eim by mal ide\u00e1lne zah\u0155\u0148a\u0165 lie\u010dbu v\u0161etk\u00fdch kateg\u00f3ri\u00ed sympt\u00f3mov, zlep\u0161ova\u0165 soci\u00e1lne fungovanie a br\u00e1ni\u0165 zhor\u0161ovaniu kognit\u00edvnych funkci\u00ed. Hlavn\u00fdm cie\u013eom vysoko \u00faspe\u0161n\u00e9ho pl\u00e1nu lie\u010dby by malo by\u0165 podstatn\u00e9 zlep\u0161enie celkovej funkcieschopnosti, ktor\u00e9 povedie k zv\u00fd\u0161eniu kvality \u017eivota.16<\/sup><\/p><\/div><\/div>\n\n\n\n

Literat\u00fara<\/p>

  1. Bowie et al. Am. J. Psychiatry. 2006; 163 (3): 418\u2013425<\/li>
  2. Medalia and Richardson. Schizophr. Bull. 2005; 31 (4): 942\u2013953<\/li>
  3. Haller CS. F1000Prime Reports 2014;6:57<\/li>
  4. NICE Psychosis and schizophrenia in adults: prevention and management 2014<\/li>
  5. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1839209\/pdf\/bmj-334-7595-cr-00686.pdf<\/a><\/li>
  6. https:\/\/www.nasmhpd.org\/sites\/default\/files\/DH-CBTp_Fact_Sheet.pdf<\/a> Cognitive Behavioral Therapy for Psychosis (CBTp): Fact Sheet, Hardy K, Stanford University Department of Psychiatry and Behavioral Health<\/li>
  7. EPA Report(27th European Congress of Psychiatry) 2019<\/li>
  8. Chien et al. Neuropsychiatric Disease and Treatment. 2013; 9: 1463\u20131481<\/li>
  9. Chue P, Lalonde JK. Neuropsychiatr Dis Treat. 2014 May 8;10:777-89. doi: 10.2147\/NDT.S43404. Review<\/li>
  10. Krause, M., Zhu, Y., Huhn, M. et al. Eur Arch Psychiatry Clin Neurosci (2018) 268: 625<\/li>
  11. Carbon M. CNS Spectr 2014;Suppl 1:38-52<\/li>
  12. Buchanan RW. Schizophr Bull 2007;33: 1013\u20131022<\/li>
  13. National Institute of Mental Health. Schizophrenia. 2009<\/li>
  14. Goff DC. Pharmacol Biochem Behav 2011;99(2):245\u2013253<\/li>
  15. Carbon M, Correll CU. Dialogues Clin Neurosci. 2014 Dec;16(4):505-24. Review. PubMed PMID: 25733955; PubMed Central PMCID: PMC4336920.<\/li>
  16. Sommi, 2017 (https:\/\/www.medscape.org\/viewarticle\/463775<\/a>) <\/li><\/ol><\/div><\/div>\n\n\n\n
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    <\/span>\u010do je to schizofr\u00e9nia?<\/span><\/h4>

    <\/span>Schizofr\u00e9niu m\u00f4\u017eeme definova\u0165 ako z\u00e1va\u017en\u00fa du\u0161evn\u00fa poruchu, ktor\u00e1 postihuje chovanie, myslenie a em\u00f3cie. Prv\u00e9 pr\u00edznaky si m\u00f4\u017eete v\u0161imn\u00fa\u0165 v dobe dospievania alebo<\/span><\/p> viac…<\/div><\/div>

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    <\/span>\u0161t\u00fadium a pr\u00e1ca so schizofr\u00e9niou<\/span><\/h4>

    <\/span>\u013dudia so schizofr\u00e9niou maj\u00fa \u010dasto s\u00fastavn\u00e9 obtia\u017ee n\u00e1js\u0165 si zamestnanie. Stigma spojen\u00e9 s du\u0161evn\u00fdm zdrav\u00edm m\u00f4\u017ee vies\u0165 k tomu, \u017ee rada zamestn\u00e1vate\u013eov a vl\u00e1dnych<\/span><\/p> viac…<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

    Aby bolo mo\u017en\u00e9 u \u013eud\u00ed so schizofr\u00e9niou zlep\u0161i\u0165 celkov\u00e9 fungovanie, je potrebn\u00e9 sa zamera\u0165 na individualizovan\u00e9 klinick\u00e9 vy\u0161etrenie…<\/p>\n","protected":false},"author":1,"featured_media":2823,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"new-text-page-design.php","meta":{"om_disable_all_campaigns":false,"rea_page_title_signed_in_meta_block_field":"Ako m\u00f4\u017ee schizofr\u00e9nia ovplyvni\u0165 fungovanie?","rea_page_title_signed_out_meta_block_field":"Ako m\u00f4\u017ee schizofr\u00e9nia ovplyvni\u0165 fungovanie?","rea_page_description_signed_in_meta_block_field":"Overall functioning is a key unmet clinical need that encompasses especially negative and cognitive symptoms, and is closely tied to quality of life.","rea_page_description_signed_out_meta_block_field":"Overall functioning is a key unmet clinical need that encompasses especially negative and cognitive symptoms, and is closely tied to quality of life.","rea_page_footer_id_meta_block_field":"","rea_page_footer_date_meta_block_field":"","footnotes":""},"categories":[],"class_list":["post-2241","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\nMana\u017ement schizofr\u00e9nie - Schizofrenia.com<\/title>\n<meta name=\"description\" content=\"Zistite, ak\u00e9 lie\u010debn\u00e9 postupy m\u00e1me k dispoz\u00edcii pri jednotliv\u00fdch f\u00e1zach schizofr\u00e9nie. 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