专家呼吁推动严重精神障碍治疗方案升级及推广社区管理治疗模式

2017-09-26 佚名 美通社

“尚善精神-白求恩-全国精神卫生高峰会”在京成功召开9月24日,在2017年世界精神卫生日(10月10日)来临前夕,由白求恩公益基金会发起、西安杨森制药有限公司支持的“尚善精神-白求恩·全国精神卫生高峰会”在京举行。来自全国近百位精神专科医院院长、医学专家、政府官员和政策研究者齐聚一堂,共同商讨新医改背景下精神疾病治疗与管理的创新发展路径。精神卫生问题既是重大公共卫生问题,也是较为突出的社会问题,




“尚善精神-白求恩-全国精神卫生高峰会”在京成功召开


9月24日,在2017年世界精神卫生日(10月10日)来临前夕,由白求恩公益基金会发起、西安杨森制药有限公司支持的“尚善精神-白求恩·全国精神卫生高峰会”在京举行。来自全国近百位精神专科医院院长、医学专家、政府官员和政策研究者齐聚一堂,共同商讨新医改背景下精神疾病治疗与管理的创新发展路径。

精神卫生问题既是重大公共卫生问题,也是较为突出的社会问题,已经成为影响人类健康及经济社会发展最为突出的挑战之一。正是在这一背景下,出席全国精神卫生高峰会的院长和专家们围绕该领域发展面临的挑战和机遇展开了深入的探讨,并就主要议题达成了广泛的共识,包括联动医院和社区的力量以推进严重精神障碍患者的治疗和康复,以及充分利用创新治疗方案的优势减少疾病复发、帮助患者恢复社会功能等。

提升现有的精神卫生服务水平,满足患者的临床需求,满足国家经济建设和社会管理的需求,已成为当务之急。严重精神障碍患者与躯体疾病患者之间最大的区别就是前者很难坚持主动服药。因此,建立便利的社区创新治疗模式对于疾病的治疗和管理是非常重要的。

国家卫生计生委于2015年发布的《全国精神卫生工作规划(2015-2020年)》中指出,我国未来需积极推行“病重治疗在医院、康复管理在社区”的服务模式,鼓励引导社会资源提供精神障碍社区康复服务。

精神分裂症是一种慢性、迁延性精神障碍。高复发是精神分裂症治疗的主要难题和挑战,服药依从性低是复发的主要原因。接受全病程、系统性的治疗至关重要。目前我国医院社区一体化精神卫生服务体系通过十多年的建设已经覆盖全国,但医疗资源分布不均,社区康复体系正在建立中,‘重院内治疗、轻社区治疗’的态势没有得到很好的改善。针对这一问题,包括长效针剂在内的方便社区使用治疗药物,以及医疗机构对社区治疗的主动指导,有望保持出院患者的疗效,减少复发,进而回归社会。

目前的口服抗精神分裂症药物治疗方案依从性普遍不佳。研究表明,中国精神分裂症患者出院后一年的复发率约为40%。首次发作的精神分裂症患者,五年内的复发率超过80%。中断药物治疗是复发的重要原因,停药患者一年内的复发率高达77%,坚持服药的患者一年内复发率为3%。在提升患者治疗依从性方面长效抗精神病针剂具有重要作用。长效抗精神病针剂与口服药物相比具有多重优势,包括提高患者的依从性、避免反复提醒患者用药、更容易安全的实现较低有效剂量原则、避免胃肠吸收等问题、不存在肝脏首过代谢效应、降低意外或故意的过量服药风险等。目前,每月注射一次的长效抗精神病治疗药物已被纳入2017版《国家医保目录》,自2017年9月1日起全国大部分省市开始执行,可有效减轻患者的经济负担。

精神分裂症的全程治疗和康复模式,主要指要为精神分裂症患者提供一个连续的、全面的医疗服务;服务场所不仅仅是在医院,还包括社区。只有社区服务不断发展完善,社区康复与医院治疗有效地衔接起来,才能真正地实现连续的、全面的服务。近年来,我国在精神分裂症患者的社区康复模式探索中已取得了较大进步,北京、武汉、上海和杭州等地已开始积极尝试社区康复模式,并已出现了令人欣喜的成绩。

据统计,全球约有4.5亿人患有不同程度的精神或行为障碍,其中,约2100万人患有精神分裂症[10]。截至2016年底,全国在册严重精神障碍患者540万例,管理率达88.7%。其中,精神分裂症患者数约占在册患者总数的3/4。由经济学人智库发布的《亚太地区精神卫生综合评价指数研究报告》估计,在2012年到2030年期间,精神疾病将导致中国的经济增长缩水超过9万亿美元。公众对精神疾病认知有限,患者面临来自于社会中的歧视或偏见,这给患者和家庭造成沉重的负担。

与会专家呼吁进一步提升严重精神障碍患者规范化治疗水平,提高疾病的治疗率,配合使用长效治疗方案,改善患者的依从性,从而降低复发率,降低疾病负担,帮助患者适应和回归社会,减少因病导致暴力极端事件的风险。

展望未来,我们将与多方合作伙伴携手,积极响应医改号召,着力确保创新药物更加便捷、高效地服务医院和患者,不断探索精神疾病管理模式,以及建设合理有效的患者服务支持体系。

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