{"id":2241,"date":"2020-01-14T13:43:51","date_gmt":"2020-01-14T13:43:51","guid":{"rendered":"https:\/\/schizofrenie.cz\/verejne\/?page_id=2241"},"modified":"2025-12-19T11:17:27","modified_gmt":"2025-12-19T10:17:27","slug":"fungovani","status":"publish","type":"page","link":"https:\/\/schizofrenie.cz\/verejne\/fungovani\/","title":{"rendered":"Jak schizofrenie naru\u0161\u00ed fungov\u00e1n\u00ed?"},"content":{"rendered":"\n
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Jak schizofrenie naru\u0161\u00ed fungov\u00e1n\u00ed?<\/h1>

Aby bylo mo\u017en\u00e9 u lid\u00ed se schizofreni\u00ed zlep\u0161it celkov\u00e9 fungov\u00e1n\u00ed, je t\u0159eba se zam\u011b\u0159it na individualizovan\u00e9 klinick\u00e9 vy\u0161et\u0159en\u00ed a l\u00e9\u010dbu negativn\u00edch a kognitivn\u00edch symptom\u016f.<\/p><\/a>

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Kognitivn\u00ed poruchy pat\u0159\u00ed mezi z\u00e1kladn\u00ed charakteristiky schizofrenie a uk\u00e1zalo se, \u017ee z\u00e1sadn\u011b ovliv\u0148uj\u00ed fungov\u00e1n\u00ed jedince.1 <\/sup>Celkov\u00e9 fungov\u00e1n\u00ed \u00fazce souvis\u00ed s kvalitou \u017eivota. Funk\u010dn\u00ed zhor\u0161en\u00ed u schizofrenie je z velk\u00e9 \u010d\u00e1sti zp\u016fsobeno negativn\u00edmi a kognitivn\u00edmi symptomy, kter\u00e9 mohou naru\u0161ovat soci\u00e1ln\u00ed fungov\u00e1n\u00ed, pracovn\u00ed pam\u011b\u0165 a v\u00fdkonn\u00e9 funkce. Je d\u016fle\u017eit\u00e9, aby byly modern\u00ed l\u00e9kov\u00e9 re\u017eimy zam\u011b\u0159eny tak\u00e9 na tuto z\u00e1sadn\u00ed nepokrytou pot\u0159ebu. I p\u0159es mno\u017estv\u00ed \u00fadaj\u016f, kter\u00e9 sv\u011bd\u010d\u00ed pro p\u0159\u00ednos postup\u016f zlep\u0161uj\u00edc\u00edch kognitivn\u00ed funkce u schizofrenie, zb\u00fdv\u00e1 je\u0161t\u011b \u0159ada nezodpov\u011bzen\u00fdch ot\u00e1zek. V\u00fdzkum se zam\u011b\u0159uje p\u0159edev\u0161\u00edm na hled\u00e1n\u00ed potenci\u00e1ln\u00edch faktor\u016f, podle nich\u017e by bylo mo\u017en\u00e9 dop\u0159edu p\u0159edpov\u011bd\u011bt \u00fa\u010dinnost rehabilitace kognitivn\u00edch funkc\u00ed, proto\u017ee \u00fa\u010dinnost l\u00e9\u010dby z velk\u00e9 \u010d\u00e1sti z\u00e1vis\u00ed na vhodn\u00e9m v\u00fdb\u011bru jedinc\u016f podle z\u00e1va\u017enosti onemocn\u011bn\u00ed a metod l\u00e9\u010dby.2<\/sup> <\/p><\/div><\/div>\n\n\n\n

Existuje i dal\u0161\u00ed c\u00edl l\u00e9\u010dby schizofrenie, o kter\u00e9m se mluv\u00ed m\u00e9n\u011b. Zach\u00e1z\u00ed d\u00e1l, ne\u017e je pouh\u00e1 snaha o sn\u00ed\u017een\u00ed \u010detnosti psychotick\u00fdch epizod, a \u010dasto se na n\u011bj l\u00e9\u010dba nezam\u011b\u0159uje tak, jako na pozitivn\u00ed symptomy: je j\u00edm fungov\u00e1n\u00ed jedince.1<\/sup>
Zlep\u0161en\u00ed funk\u010dn\u00ed kapacity jedince ovlivn\u00ed jeho kvalitu \u017eivota, kter\u00e1 je nakonec stejn\u011b v\u00fdznamn\u00e1 jako l\u00e9\u010dba pozitivn\u00edch symptom\u016f. P\u0159\u00edstup k l\u00e9\u010db\u011b je v\u00edcefaktorov\u00fd a obvykle zahrnuje: pod\u00e1v\u00e1n\u00ed psychofarmak, psychologick\u00e9 z\u00e1sahy a pomoc s bydlen\u00edm a finan\u010dn\u00edm zaji\u0161t\u011bn\u00edm.3<\/sup>

Zcela z\u00e1sadn\u00ed je individu\u00e1ln\u011b p\u0159izp\u016fsoben\u00fd klinick\u00fd postup (obr. 1). K dodr\u017eov\u00e1n\u00ed l\u00e9\u010dby, jej\u00ed \u00fa\u010dinnosti a kontinuit\u011b p\u00e9\u010de jsou pot\u0159ebn\u00e9 pravideln\u00e9 kontroly jedince, dosa\u017een\u00e9ho klinick\u00e9ho pokroku a posouzen\u00ed pot\u0159ebn\u00fdch zm\u011bn re\u017eimu l\u00e9\u010dby.4<\/sup>

K dispozici je n\u011bkolik mo\u017enost\u00ed l\u00e9\u010dby, kter\u00e9 se vyu\u017e\u00edvaj\u00ed v z\u00e1vislosti na p\u0159\u00edpadu a z\u00e1va\u017enosti onemocn\u011bn\u00ed.<\/p><\/div><\/div>\n\n\n\n

Akutn\u00ed psychotick\u00e9 epizody
P\u0159i akutn\u00ed psychotick\u00e9 epizod\u011b je nejd\u016fle\u017eit\u011bj\u0161\u00ed zm\u00edrnit pozitivn\u00ed symptomy. V t\u011bchto p\u0159\u00edpadech je volbou \u010d\u00edslo jedna adekv\u00e1tn\u00ed farmakoterapie a posouzen\u00ed funkceschopnosti. Z\u00e1sadn\u00ed je vybrat l\u00e9ky, kter\u00e9 nebudou m\u00edt na pacienta tlumiv\u00e9 (sedativn\u00ed) \u00fa\u010dinky nebo nesnesiteln\u00e9 vedlej\u0161\u00ed \u00fa\u010dinky, kter\u00e9 by mohly b\u00fdt nep\u0159\u00edzniv\u00fdm „iatrogenn\u00edm“ (l\u00e9\u010dbou navozen\u00fdm) faktorem ovliv\u0148uj\u00edc\u00edm funkceschopnost. Je bezpe\u010dn\u011bj\u0161\u00ed dos\u00e1hnout sedace pomoc\u00ed benzodiazepin\u016f pod\u00e1van\u00fdch v nejni\u017e\u0161\u00ed \u00fa\u010dinn\u00e9 d\u00e1vce, ne\u017e antipsychotiky. V\u00fdb\u011br siln\u011b sedativn\u00edho antipsychotika s tomto stadiu m\u016f\u017ee br\u00e1nit pozd\u011bj\u0161\u00edmu propu\u0161t\u011bn\u00ed z nemocnice. 5<\/sup> <\/p>

Chronick\u00e9 psychotick\u00e9 epizody
Pozitivn\u00ed symptomy se u v\u0161ech diagn\u00f3z l\u00e9\u010d\u00ed podobn\u011b, i kdy\u017e se pou\u017e\u00edvaj\u00ed jin\u00e9 d\u00e1vky, re\u017eimy a d\u00e9lka l\u00e9\u010dby. Pokud ov\u0161em nejsou pozitivn\u00ed symptomy tak \u010dast\u00e9 nebo nejsou p\u0159\u00edtomny v\u016fbec a v klinick\u00e9m obraze p\u0159eva\u017euj\u00ed negativn\u00ed a kognitivn\u00ed symptomy, je zde prostor pro jin\u00fd druh l\u00e9\u010dby. U m\u00edrn\u00e9 nebo st\u0159edn\u011b z\u00e1va\u017en\u00e9 deprese a \u00fazkosti je nap\u0159\u00edklad jako l\u00e9\u010dba prvn\u00ed volby doporu\u010dov\u00e1na kognitivn\u011b-behavior\u00e1ln\u00ed terapie.6<\/sup> V takov\u00fdch p\u0159\u00edpadech se tak\u00e9 velmi doporu\u010duje \u00faprava \u017eivotn\u00edho stylu a pravideln\u00e1 fyzick\u00e1 z\u00e1t\u011b\u017e, proto\u017ee bylo prok\u00e1z\u00e1no, \u017ee upravuj\u00ed funkce mozku, proto\u017ee zlep\u0161uj\u00ed pam\u011b\u0165, schopnost plnit v\u00edce \u00fakol\u016f najednou a schopnost pl\u00e1novat, navozuj\u00ed obnovu mozkov\u00fdch bun\u011bk a d\u00e9lku soust\u0159ed\u011bn\u00ed.7<\/sup> A kone\u010dn\u011b jsou pro udr\u017een\u00ed remise z\u00e1sadn\u00ed finan\u010dn\u00ed podpora a napln\u011bn\u00ed kari\u00e9rn\u00edch c\u00edl\u016f.<\/p><\/div><\/div><\/div>\n\n\n\n

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Obr. 1: Zlep\u0161en\u00ed fungov\u00e1n\u00ed u schizofrenie<\/p><\/div><\/div>\n\n\n\n

Pokud je t\u0159eba zlep\u0161it funkceschopnost, je z\u00e1kladn\u00edm bodem, kter\u00fd je nutn\u00e9 zv\u00e1\u017eit, tak\u00e9 l\u00e9\u010dba negativn\u00edch symptom\u016f<\/a> (obr. 1).3<\/sup> P\u0159esto\u017ee negativn\u00ed symptomy postihuj\u00ed a\u017e 26 % pacient\u016f se schizofreni\u00ed a a\u017e 58 % ambulantn\u00edch pacient\u016f se schizofreni\u00ed, h\u016f\u0159 reaguj\u00ed na sou\u010dasn\u00e9 l\u00e9ky ne\u017e pozitivn\u00ed symptomy.9 <\/sup>\u00da\u010dinnost na negativn\u00ed symptomy nav\u00edc prok\u00e1zalo jen n\u011bkolik antipsychotik.10 <\/sup>Z tohoto d\u016fvodu z\u016fst\u00e1v\u00e1 nedostatek \u00fa\u010dinn\u00fdch l\u00e9k\u016f pro l\u00e9\u010dbu negativn\u00edch symptom\u016f v\u00fdznamnou nespln\u011bnou pot\u0159ebou, zejm\u00e9na pokud zv\u00e1\u017e\u00edme v\u00fdznam t\u011bchto p\u0159\u00edznak\u016f na v\u00fdsledky v\u00fdsledky dosahovan\u00e9 u pacient\u016f<\/a>.9<\/sup> Proto je zcela z\u00e1sadn\u00ed negativn\u00ed symptomy rozpoznat, pochopit a rychle \u0159e\u0161it, proto\u017ee \u010dasn\u00fd z\u00e1sah m\u016f\u017ee v\u00fdrazn\u011b ovlivnit celkov\u00e9 fungov\u00e1n\u00ed a n\u00e1sledn\u011b i kvalitu \u017eivota.8<\/sup>

Krom\u011b negativn\u00edch symptom\u016f je tu dal\u0161\u00ed kategorie p\u0159\u00edznak\u016f, na kter\u00e9 schv\u00e1len\u00e9 l\u00e9ky nec\u00edl\u00ed: kognitivn\u00ed symptomy (obr. 1). I tyto p\u0159\u00edznaky souvisej\u00ed s celkovou funkceschopnost\u00ed a z\u016fstavaj\u00ed nepokrytou medic\u00ednskou pot\u0159ebou.11,12 <\/sup>Kognitivn\u00ed p\u0159\u00edznaky naru\u0161uj\u00ed v\u00fdkonn\u00e9 funkce, zejm\u00e9na rozhodov\u00e1n\u00ed a zpracov\u00e1n\u00ed informac\u00ed, vedou k nedostate\u010dn\u00e9 pozornosti a zhor\u0161en\u00ed pracovn\u00ed pam\u011bti.13 <\/sup>Tyto p\u0159\u00edznaky maj\u00ed se z\u0159ejmou pravd\u011bpodobnost\u00ed dopad na kvalitu \u017eivota a ka\u017edodenn\u00ed fungov\u00e1n\u00ed pacienta. V\u00fdzkum kognitivn\u00edch symptom\u016f v n\u011bkolika posledn\u00edch desetilet\u00edch zna\u010dn\u011b pokro\u010dil. Modern\u00ed l\u00e9ky a re\u017eimy ale st\u00e1le sv\u00e1d\u011bj\u00ed marn\u00fd boj p\u0159i dosa\u017een\u00ed v\u00fdrazn\u00e9ho zlep\u0161en\u00ed t\u00e9to kategorie p\u0159\u00edznak\u016f. \u00dasp\u011b\u0161n\u00e9 v\u00fdsledky pilotn\u00edch studi\u00ed zam\u011b\u0159en\u00fdch na kognitivn\u00ed p\u0159\u00edznaky nebyly potvrzeny ve velk\u00fdch studi\u00edch. To dokl\u00e1d\u00e1, \u017ee st\u00e1le je nutn\u00fd rozs\u00e1hl\u00fd v\u00fdzkum zam\u011b\u0159en\u00fd na tuto problematiku.14<\/sup>

Hlavn\u00edm c\u00edlem dne\u0161n\u00edch l\u00e9kov\u00fdch re\u017eim\u016f je zlep\u0161it celkov\u00e9 fungov\u00e1n\u00ed. Dosud bylo v\u011bt\u0161iny klinick\u00e9ho \u00fasp\u011bchu dosa\u017eeno vy\u0159e\u0161en\u00edm pozitivn\u00edch symptom\u016f. Modern\u00ed terapeiutick\u00e9 mo\u017enosti by se m\u011bly zam\u011b\u0159ovat tak\u00e9 na negativn\u00ed a kognitivn\u00ed symptomy a m\u011bly by b\u00fdt \u010dasto a pravideln\u011b p\u0159ehodnocov\u00e1ny a upravov\u00e1ny podle individu\u00e1ln\u00edch pot\u0159eb a preferenc\u00ed.15<\/sup> \u00dasp\u011b\u0161n\u00fd antipsychotick\u00fd re\u017eim by m\u011bl ide\u00e1ln\u011b zahrnovat l\u00e9\u010dbu v\u0161ech kategori\u00ed symptom\u016f, zlep\u0161ovat soci\u00e1ln\u00ed fungov\u00e1n\u00ed a br\u00e1nit zhor\u0161en\u00ed kognitivn\u00edch funkc\u00ed. Hlavn\u00edm c\u00edlem vysoce \u00fasp\u011b\u0161n\u00e9ho pl\u00e1nu l\u00e9\u010dby by m\u011blo b\u00fdt podstatn\u00e9 zlep\u0161en\u00ed celkov\u00e9 funkceschopnosti, kter\u00e9 povede ke zv\u00fd\u0161en\u00ed kvality \u017evota.16<\/sup> <\/p><\/div><\/div>\n\n\n\n

Literatura<\/p>

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  2. Medalia and Richardson. Schizophr. Bull. 2005; 31 (4): 942\u2013953<\/li>
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  4. NICE Psychosis and schizophrenia in adults: prevention and management 2014<\/li>
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  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>
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  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\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-fullwidth.php","meta":{"rea_page_title_signed_in_meta_block_field":"jak m\u016f\u017ee schizofrenie ovlivnit fungov\u00e1n\u00ed?","rea_page_title_signed_out_meta_block_field":"jak m\u016f\u017ee schizofrenie ovlivnit fungov\u00e1n\u00ed?","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":""},"class_list":["post-2241","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/pages\/2241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/comments?post=2241"}],"version-history":[{"count":27,"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/pages\/2241\/revisions"}],"predecessor-version":[{"id":3311,"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/pages\/2241\/revisions\/3311"}],"wp:attachment":[{"href":"https:\/\/schizofrenie.cz\/verejne\/wp-json\/wp\/v2\/media?parent=2241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}