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Guideline National Klinisk Retningslinje For 1 of 137 National Klinisk Retningslinje for behandling af patienter med skizofreni og komplekse behandlingsforløb - vedvarende symptomer, misbrug eller Hovedforfatter Sundhedsstyrelsen, 2015 Publiceringsinformation v1.1 published on 21.08.2018 National Klinisk Retningslinje for behandling af patienter med skizofreni og komplekse behandlingsforløb - vedvarende symptomer, misbrug eller mangelfuld behandlingstilknytning Kontaktperson Sundhedsstyrelsen Islands Brygge 67 [email protected] +4572227400 Sponsorer / Finansiering Sundhedsstyrelsen Ansvarsfraskrivelse Dette er en digital version af retningslinjen, som er udgivet af Sundhedsstyrelsen d. 22. maj 2015. Den oprindelige version findes på Sundhedsstyrelsens hjemmeside. Sundhedsstyrelsens nationale kliniske retningslinjer er systematisk udarbejdede udsagn med inddragelse af relevant sagkundskab. Nationale kliniske retningslinjer kan bruges af fagpersoner, når de skal træffe beslutninger om passende og god klinisk sundhedsfaglig ydelse i specifikke situationer. De nationale kliniske retningslinjer er offentligt tilgængelige, og patienter kan også orientere sig i retningslinjerne. Nationale kliniske retningslinjer klassificeres som faglig ådgivning,r hvilket indebærer, at Sundhedsstyrelsen anbefaler relevante fagpersoner at følge retningslinjerne. De nationale kliniske retningslinjer er ikke juridisk bindende, og det vil altid være det faglige skøn i den konkrete kliniske situation, der er afgørende for beslutningen om passende og korrekt sundhedsfaglig ydelse. Der er ingen garanti for et succesfuldt behandlingsresultat, selvom sundhedspersoner følger anbefalingerne. I visse tilfælde kan en behandlingsmetode med lavere evidensstyrke være at foretrække, fordi den passer bedre til patientens situation. Sundhedspersoner skal generelt inddrage patienten, når de vælger behandling. 2 of 137 National Klinisk Retningslinje for behandling af patienter med skizofreni og komplekse behandlingsforløb - vedvarende symptomer, misbrug eller Indhold Centrale budskaber.................................................................................................................................................................................................................................................4 1 - Læsevejledning ................................................................................................................................................................................................................................................12 2 - Indledning...........................................................................................................................................................................................................................................................14 3 - Farmakologisk behandling...........................................................................................................................................................................................................................17 3.1 - Reduktion af clozapin-dosis ved plasmakoncentration over den øvre grænse i det vejledende terapeutiske interval ...........................17 3.2 - Depotbehandling med antipsykotiske lægemidler ..............................................................................................................................................................20 3.3 - Tillægsbehandling med SSRI/SNRI.............................................................................................................................................................................................28 3.4 - Ophør med antipsykotisk behandling .......................................................................................................................................................................................37 4 - Psykoterapeutiske og psykosociale interventioner ..........................................................................................................................................................................45 4.1 - Familieintervention ..........................................................................................................................................................................................................................45 4.2 - Neurokognitiv træning....................................................................................................................................................................................................................50 4.3 - Socialkognitiv træning.....................................................................................................................................................................................................................54 4.4 - Kognitiv adfærdsterapi ...................................................................................................................................................................................................................60 5 - Misbrug og mangelfuld behandlingstilknytning .................................................................................................................................................................................66 5.1 - Kognitiv adfærdsterapi og Motivational Interviewing ved misbrug af cannabis og/eller centralstimulerende stoffer ..........................66 5.2 - Assertive community treatment (ACT) ....................................................................................................................................................................................72 6 - Baggrund ............................................................................................................................................................................................................................................................79 7 - Implementering ...............................................................................................................................................................................................................................................80 8 - Monitorering.....................................................................................................................................................................................................................................................81 9 - Opdatering og videre forskning ................................................................................................................................................................................................................82 10 - Beskrivelse af anvendt metode...............................................................................................................................................................................................................83 11 - Fokuserede spørgsmål ...............................................................................................................................................................................................................................84 12 - Beskrivelse af anbefalingernes styrke og implikationer...............................................................................................................................................................88 13 - Søgestrategi....................................................................................................................................................................................................................................................90 14 - Evidensvurderinger.................................................................................................................................................................................................................................. 113 15 - Arbejdsgruppen og referencegruppen ............................................................................................................................................................................................. 114 16 - Ordliste.......................................................................................................................................................................................................................................................... 116 17 - Referenceliste............................................................................................................................................................................................................................................. 117 Referencer ............................................................................................................................................................................................................................................................ 137 3 of 137 National Klinisk Retningslinje for behandling af patienter med skizofreni og komplekse behandlingsforløb - vedvarende symptomer, misbrug eller Centrale budskaber 1 - Læsevejledning 2 - Indledning 3 - Farmakologisk behandling 3.1 - Reduktion af clozapin-dosis ved plasmakoncentration over den øvre grænse i det vejledende terapeutiske interval God Praksis (Konsensus) Hos patienter med skizofreni i behandling med clozapin er det god praksis at justere dosis efter klinisk effekt og bivirkninger. Øvre grænse i det vejledende terapeutiske interval kan overskrides, men bør altid medføre overvejelser om dosisreduktion
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