抗精神病药对男性精神分裂症患者垂体-性腺轴的影响

目的：研究氯丙嗪、利培酮、奎硫平及奥氮平对男性精神分裂症患者垂体．性腺轴的影响。方法：88例首发男性精神分裂症患者随机分为氯丙嗪组、利培酮组、奎硫平组及奥氮平组，检测治疗前、治疗4周及8周血清促卵泡素（FSH）、黄体生成素（LH）、催乳素（PRL）、睾酮（T）的水平变化。结果：氯丙嗪组治疗8周后，血清PRL水平显著高于治疗前。利培酮组在治疗4周及8周后PRL水平均显著高于治疗前，治疗8周后T及LH水平显著低于治疗前。奎硫平组在治疗4周及8周后血清PRL、LH、T水平与治疗前比较差异均无显著性。奥氮平组治疗4周后PRL水平显著高于治疗前，治疗8周后即与治疗前差异无显著性。结论：奎硫平对垂体．性腺轴激素水平无明显影响。     

奥氮平、奎硫平与阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素水平的影响

目的:探讨非典型抗精神病药奥氮平、奎硫平、阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素(PRL)水平的影响方法:将150例精神分裂症患者随机分为奥氮平、奎硫平及阿立哌唑组并接受相应的药物治疗8周。治疗前后分别检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(T3)、总甲状腺素(T4)、促甲状腺激素(TSH)及PRL水平。结果:治疗后3组血清FT4、T3、T4水平较治疗前明显下降(P均0.01);T4组间主效应有统计学意义(P0.05);治疗后奎硫平组血清T4水平较奥氮平组下降更明显(P0.05);治疗后奥氮平组血清PRL水平明显高于治疗前及奎硫平及阿立哌唑组(P均0.01),并具有交互作用(P0.01)。结论:奥氮平、奎硫平、阿立哌唑都降低甲状腺激素水平,奎硫平更易降低T4水平;奥氮平显著影响血清PRL水平。     

奎硫平与氯丙嗪对血清催乳素的影响

目的:探讨奎硫平与氯丙嗪对精神分裂症患者血清催乳素(PRL)的影响及血清PRL水平与药物疗效的相互关系。方法:对191例精神分裂症患者分别以奎硫平或氯丙嗪治疗。以阳性与阴性症状量表(PANSS)进行评估,同时测血清PRL浓度,于治疗前及治疗8周时各测1次。结果:经8周治疗,氯丙嗪组血清PRL(680.23±90.26)μg/L,显著高于奎硫平组(124.24±13.56)μg/L(P<0.001)。奎硫平组男女患者血清PRL水平差异无显著性(P>0.05);氯丙嗪组女性血清PRL(785.72±15.81)μg/L,显著高于男性的(557.75±99.23)μg/L(P<0.05),两组患者血清PRL浓度与PANSS减分率均无显著相关。结论:奎硫平对精神分裂症患者血清PRL水平基本无影响,氯丙嗪可明显升高患者血清PRL水平。血清PRL水平与药物疗效无显著相关。     

抗精神病药对血浆甲状腺激素水平的影响

目的：了解氯丙嗪、奎硫平及利培酮对甲状腺激素的影响。方法：对82例女性初发精神分裂症患者在3种药物治疗前、治疗2周及4周分别检测三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)的血浆水平，比较甲状腺激素水平。结果：3组在治疗2周T4及FT4水平有显著差异；氯丙嗪组治疗2周、4周T3、FT3水平显著下降；奎硫平组治疗2周、4周T3、FT3、FT4水平显著增加。结论：氯丙嗪可致甲状腺激素水平下降，而奎硫平可能增加，利培酮不影响。     

奎硫平与利培酮对血清催乳素影响对照研究

目的:探讨奎硫平与利培酮对女性患者血清催乳素(PRL)及体质量指数(BMI)的影响。方法:将60例精神分裂症或分裂样精神病女性患者随机分为奎硫平组和利培酮组,每组各30例,采用磁酶免疫法测定两组治疗前后的PRL水平,并计算治疗前后体质量指数。结果:治疗后利培酮组PRL显著高于治疗前PRL(t=6.165,P<0.01)。治疗后利培酮组BMI和奎硫平组BMI均显著高于治疗前(P均<0.05),利培酮组高于奎硫平组(t=3.013,P<0.01)。结论:奎硫平对PRL影响不明显,利培酮对PRL影响明显。     

第2代抗精神病药对代谢的影响

目的：探讨奥氮平、奎硫平和齐拉西酮对首发精神分裂症患者血脂和体质量的影响。方法：选择件院治疗的首发精神分裂症患者114例．随机分为奥氮平组35例、奎硫平组41例、齐拉西酮组38例治疗前、治疗4周和治疗8周检测血脂水平和体质量。结果：奥氮平组治疗4周、治疗8周总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;高密度脂蛋白胆固醇（HDL）水平垃著降低（P〈0．05）;奎硫平组至治疗8周时,TC、TG、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;而齐拉西酮组治疗4周和治疗8周与治疗前比较,TC、TG、HDL、LDL、体质量水平差异均无显著性。在治疗8周奥氮平组、奎硫平组TC、TG、HDL、LDL、体质餐变化与齐拉西酮组比较差异有显著性（P〈0．05）。结论：齐拉西酮对精神分裂症患者血脂和体质量的影响较奥氮平、奎硫平小,奥氮平和奎硫平在精神分裂症治疗过程中均可导致血脂异常和体质量增加。     

喹硫平与利培酮对血清催乳素影响的研究

目的了解喹硫平与利培酮对精神分裂症患者的疗效及对血清催乳素的影响。方法对71例符合CCMD-3诊断标准的精神分裂症患者随机分为喹硫平治疗组（33例）与利培酮治疗组（38例）,观察12周,分别于治疗前及治疗后4周、8周、12周予以阳性症状与阴性症状量表（PANSS）,副反应量表（TESS）及血清催乳素测定。结果喹硫平组和利培酮组疗效差异无显著性,两组治疗后4周、8周及12周PANSS总分及各因子分显著下降（P〈0.01）,利培酮组的不良反应高于喹硫平组,主要表现在肌强直、震颤、泌乳（χ^2=5.69,P〈0.01）及闭经（χ^2=6.74,P〈0.01）等不良反应上,利培酮组治疗后4周、8周及12周血清催乳素明显增加（t=13.48,P〈0.01）,而喹硫平组治疗前后无差异。结论喹硫平与利培酮对精神分裂症均有效,但利培酮不良反应大,明显升高血清催乳素,且有较高高血清催乳素不良反应,而喹硫平对血清催乳素影响较少。     

氯丙嗪与奎硫平对血脂和血糖的影响

目的:研究氯丙嗪与奎硫平对精神分裂症患者血脂与血糖的影响。方法:130例精神分裂症患者随机分为氯丙嗪组(65例)与奎硫平组(65例),治疗8周。所有患者于治疗前与治疗4、8周测空腹血糖、总胆固醇、三酰甘油和体质量(体重)。结果:氯丙嗪组总胆固醇、三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01);奎硫平组三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01)。治疗8周后,两组男性患者总胆固醇与空腹血糖较治疗前均显著升高(P<0.01),女性患者三酰甘油与总胆固醇治疗后较治疗前显著升高(P<0.01)。结论:氯丙嗪与奎硫平对血脂和血糖的影响不同,2药对血脂与血糖的影响存在性别差异。     

四种非典型抗精神病药对血清催乳素和血脂的影响

目的探讨四种非典型抗精神病药对精神分裂症患者血脂和血清催乳素（PRL）的影响,以及血清PRL水平与药物疗效的关系。方法118例精神分裂症患者分为4组,分别予以喹硫平（29例）、氯氮平（30例）、奥氮平（30例）和利培酮（29例）治疗12周。于治疗前及治疗4、8及12周末予以阳性与阴性症状量表（PANSS）评定,测定血总胆固醇（TC）、甘油三脂（TG）高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、阿朴脂蛋白A—I（ApoA-1）、阿朴脂蛋白-B（Apo—B）及血清PRL浓度。结果（1）喹硫平组TG、HDL在12周末有显著升高（P〈0．05）,氯氮平组Apo—B在4、12周末有显著升高（P〈0．05）、LDL在8、12周末有显著升高（P〈0．05）,利培酮组除TG外其余血脂指标在8、12周末有显著升高（P〈0．05）,奥氮平组TG、HDL、LDL、ApoA-1、Apo—B在12周末有显著升高（P〈0．05）,TC在8与12周有显著升高（P〈0．05）。（2）利培酮组治疗8、12周后血清PRL明显升高（P〈0．01）。（3）氯氮平组和利培酮组PANSS一般病理分的减分率分别与PRL、LDL有显著相关;氯氮平组PRL与LDL有显著相关。结论利培酮、奥氮平、喹硫平和氯氮平均影响血脂代谢;氯氮平疗效与血清催乳素及LDL有关,利培酮疗效与LDL有关。     

氯氮平和利培酮对催乳素、甲状腺素的影响

目的：比较氯氮平、利培酮对精神分裂症患者血清催乳素（PRL）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）的影响。方法：将68例精神分裂症患者随机分为氯氮平组和利培酮组，治疗6周。用磁酶免疫法在治疗前后分别测定血清PRL、T3、T4水平。结果：氯氮平组治疗后血清PRL、T3、T4均增高，治疗前后差异有显著性；但血清PRL、T3、T4的改变无性别的差异；利培酮血清PRL治疗后较治疗前高，T3、T4较治疗前低，差异均有显著性，也无性别的差异。结论：氯氮平和利培酮治疗均明显增加血清催乳素水平，利培酮增加幅度更大。氯氮平增加T3、T4水平，而利培酮降低T3、T4水平。     

Effectiveness of antipsychotic maintenance therapy with quetiapine in comparison with risperidone and olanzapine in routine schizophrenia treatment: results of a prospective observational trial

Objective of this observational trial is to examine the effects of quetiapine in comparison with olanzapine and risperidone on clinical outcomes and quality of life in patients with schizophrenia and schizoaffective disorder in routine care. 374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine, or risperidone at discharge from inpatient treatment were included. Clinical and psychosocial outcomes were assessed before discharge and at 6, 12, 18, and 24?months. Statistical analyses were conducted by mixed-effects regression models for longitudinal data. The propensity score method was used to control for selection bias. Patients discharged on olanzapine had significantly lower hospital readmissions than those receiving quetiapine or risperidone. The average chlorpromazine equivalent dose of quetiapine was higher than in patients treated with olanzapine or risperidone. No further significant differences between treatment groups were found. Quetiapine and risperidone are less effective in preventing the need for psychiatric inpatient care than olanzapine, and higher chlorpromazine equivalent doses of quetiapine are needed to obtain clinical effects similar to those of olanzapine and risperidone.     

A randomized, flexible-dose, quasi-naturalistic comparison of quetiapine, risperidone, and olanzapine in the short-term treatment of schizophrenia: the QUERISOLA trial

This was a randomized, flexible-dose, rater-blind, parallel-group, quasi-naturalistic trial comparing the efficacy, safety, and tolerability of quetiapine, risperidone, and olanzapine in patients with schizophrenia hospitalized for severe psychotic symptoms. Seventy-five patients were randomized to quetiapine (n=25), risperidone (n=25), or olanzapine (n=25). Mean doses at Week 8 were: 590.0 mg/day quetiapine; 5.1 mg/day risperidone; 15.1 mg/day olanzapine. Four quetiapine, five risperidone, and five olanzapine patients discontinued prior to Week 8. There were no significant differences between groups in the primary efficacy measures of improvement from baseline in Positive and Negative Syndrome Scale (PANSS) total score at Week 8 in the per protocol (PP) population and the number of completers who experienced >or=40% improvement on the same scale. PP and intent-to-treat analyses showed significant improvement from baseline in each component of a PANSS-derived battery, without significant differences between treatments. No quetiapine patients, one risperidone, and four olanzapine patients reported an adverse event (AE) of moderate intensity; no severe AEs were reported. A linear mixed model for repeated measures showed an effect of treatment on body weight, with significant differences favoring quetiapine over risperidone and olanzapine. Simpson-Angus Scale scores were significantly worse with risperidone compared with both olanzapine and quetiapine at Week 3 and compared with quetiapine thereafter. Use of concomitant medications for anxiety or tension was significantly less frequent with quetiapine. In conclusion, quetiapine, risperidone, and olanzapine have similar efficacy in schizophrenia, but there are drug-specific differences for some AEs and in the use of concomitant medication that differentiate these agents.     

抗精神病药对男性精神分裂症患者性功能影响的相关性分析

目的 探讨抗精神病药喹硫平、利培酮、氯丙嗪及氯氮平对男性精神分裂症患者性功能影响的差异及相关因素分析.方法 将门诊就诊的男性精神分裂症患者120例,随机分为喹硫平组38例、利培酮组41例、氯丙嗪39例、氯氮平组42例.应用酶联免疫吸附法检测血清泌乳素、放射免疫法检测睾酮水平,检测各组患者治疗前及治疗第12周末的血清泌乳素(PRL)和睾酮水平.分别于基线及治疗第12周末使用简明男性性功能量表、阳性与阴性症状量表(PANSS)评估性功能及精神症状,于治疗第12周末用副反应量表(TESS)评估药物治疗的不良反应.结果 治疗第12周末,利培酮组、氯丙嗪组、氯氮平组的性功能量表总分较治疗前降低(P＜0.05).利培酮组和氯丙嗪组治疗第12周末的血清泌乳素水平高于基线水平[利培酮组:(12±5)ng/ml,(22±6)ng/ml,t=13.92,P＜0.01;氯丙嗪组:(13±6)ng/ml,(19±5)ng/ml,t=8.27,P＜0.01],喹硫平组和氯氮平组无明显变化.利培酮组和氯丙嗪组治疗第12周末的血睾酮水平低于基线水平:利培酮组:(0.77±0.21)ng/ml,(0.27±0.11)ng/ml,t=13.22,P＜0.01;氯丙嗪组:(0.90±0.11)ng/ml,(0.32±0.14)ng/ml,t=11.27,P＜0.01;喹硫平组和氯氮平组无明显变化.影响男性精神分裂症患者性功能的因素有泌乳素、睾酮、年龄及TESS分.结论 抗精神病药物中,利培酮和氯丙嗪易引起血清泌乳素升高和血清睾酮降低,氯氮平具有较多药物不良反应,这些可能造成男性精神分裂症患者的性功能减退.     

奥氮平与利培酮治疗首发精神分裂症对照研究

目的 比较奥氮平与利培酮治疗首发精神分裂症的疗效及不良反应。方法 随机将符合CCMD-2R精神分裂症的诊断标准70例患者进入奥氮平或利培酮组接受治疗,分别在治疗0、1、2、4、6、8周评定PANSS和TESS量表,在0、4、8周检查心脑电图和肝肾功能,在0、8周检查血催乳素和空腹血糖。结果 奥氮平与利培酮疗效相当,奥氮平能迅速减轻精神症状,其产生的不良反应少、严重程度轻,很少引起血催乳素变化;利培酮会显著提高血催乳素水平。结论 奥氮平对首发精神分裂症治疗安全有效。     

Serum leptin and triglyceride levels in patients on treatment with atypical antipsychotics

BACKGROUND: Weight gain is a common adverse effect associated with the use of most antipsychotic drugs. Leptin has been reported to be associated with antipsychotic-induced weight gain. Previous studies have demonstrated a relationship between the atypical antipsychotics clozapine and olanzapine and serum leptin levels. We planned to comparatively investigate the effects of the atypical antipsychotics quetiapine, olanzapine, risperidone, and clozapine on leptin and triglyceride levels and weight gain. METHOD: The study population comprised 56 patients with DSM-IV schizophrenia, who were divided into 4 treatment groups: quetiapine (N = 14), olanzapine (N = 14), risperidone (N = 14), or clozapine (N = 14) monotherapy, and a control group of 11 patients receiving no psychopharmacologic treatment. The patients were evaluated at baseline and at the sixth week according to the Positive and Negative Syndrome Scale (PANSS), body mass index (BMI), weight, and fasting serum leptin and triglyceride levels. Data were gathered in 2001 and 2002. RESULTS: Olanzapine and clozapine caused a marked increase in weight and serum triglyceride and leptin levels, though increases in these variables were modest in the patients receiving quetiapine and minimal in those receiving risperidone. There were positive correlations between serum leptin levels and BMI and triglyceride levels. Clinical efficacy, as indicated by decrease in total PANSS scores, was associated with leptin levels in all atypical antipsychotic groups. CONCLUSION: Our results suggest that leptin may be associated with olanzapine- and clozapine-induced weight gain and that quetiapine appears to have modest influence and risperidone appears to have minimal influence on leptin and triglyceride levels and weight gain compared with olanzapine and clozapine.     

奥氮平与利培酮治疗青少年首发精神分裂症对照研究

目的比较奥氮平与利培酮治疗青少年首发精神分裂症的疗效和安全性。方法对60例青少年期首发精神分裂症患者随机分为两组,分别给予奥氮平与利培酮治疗8周。于治疗前及治疗后1、2、6、8周末进行阳性和阴性症状量表(PANSS)及副反应量表(TESS)评定。结果奥氮平与利培酮总的疗效无显著性差异,均能快速起效,PANSS总分比较治疗第1周与第2周末奥氮平组显著低于利培酮组,利培酮组锥体外系反应显著多于奥氮平组。结论奥氮平与利培酮均是治疗首发青少年精神分裂症安全有效的非典型抗精神病药物,可根据患者的不同情况分别选择。     

抗精神病药对精神分裂症患者认知功能的影响

目的：比较非经典抗精神病药奎硫平、奥氮平、氯氮平与经典抗精神病药氯丙嗪对精神分裂症患者认知功能的影响。方法：对160例住院精神分裂症患者随机开放分配接受奎硫平、奥氮平、氯氮平和氯丙嗪药物治疗。12周的急性期治疗后,获得临床稳定期的患者[阳性与阴性量表（PANSS）总分≤60或减分率／〉50％]进入固定剂量的24周治疗。分别在基线、治疗12周和24周进行威斯康星卡片分类测验（WCST）、言语流畅性测验、霍普金斯词语学习测验（HVLT-R）、持续操作功能测验（CPT）、韦克斯勒记忆测定（WMS）、韦克斯勒智能测定（WAIS）、连线试验测定、手指叩击试验测定。结果：奎硫平组、奥氮平组、氯氮平组治疗12周和24周后认知功能均有不同程度的改善（P均〈0．05）,明显优于氯丙嗪,而氯丙嗪组无显著改善。治疗12周后奎硫平组在改善执行功能、言语流畅性和警觉性显著优于奥氮平组和氯氮平组（P〈0．05）。奥氮平组在数字特征和连线测定上明显优于氯氮平组（P〈0．05）。3种非经典抗精神病药在认知功能总分的改善与PANSS总分、阴性症状分的改善有显著相关性（r=-0．32,P〈0．05）。结论：3种非经典抗精神病药奎硫平、奥氮平、氯氮平可不同程度改善精神分裂症患者的认知功能。     

Comparative effects of risperidone and olanzapine on cognition in elderly patients with schizophrenia or schizoaffective disorder

OBJECTIVE: To examine the effects of risperidone and olanzapine on cognitive functioning in elderly patients with schizophrenia or schizoaffective disorder. METHOD: One hundred seventy-six elderly inpatients and outpatients with schizophrenia or schizoaffective disorder were enrolled in this multicenter, double-blind trial. After their antipsychotic medications were tapered for 1 week, patients were randomly assigned to receive either risperidone 1 to 3 mg/day or olanzapine 5 to 20 mg/day for 8 weeks. Performance on the Continuous Performance Test (CPT), Serial Verbal Learning Test (SVLT), TMT (Trail Making Test) Parts A and B, Wisconsin Card Sorting Test (WCST), and Verbal Fluency Examinations (VFE) was assessed at baseline and at end point. RESULTS: Patients in the risperidone group had improved scores on at least one test of attention, memory, executive function, and verbal fluency, and those in the olanzapine group had improved scores on at least one test of attention and memory function. Scores on the TMT Part B, WCST total errors (executive function domain), and the VFE improved significantly from baseline in the risperidone group but not in the olanzapine group. No significant differences in change scores between the two groups were found. Higher baseline scores on each test predicted more improvement at endpoint. CONCLUSIONS: Low doses of risperidone and olanzapine improve cognitive function in elderly patients with schizophrenia or schizoaffective disorder. Consistent with research in younger populations, these improvements occur in aspects of cognitive functioning related to functional outcome.