非经典抗精神病药对代谢的影响

目的：探讨非经典抗精神病药对精神分裂症患者血糖、糖化血红蛋白（HbA1C）、三酰甘油（TG）、高密度脂蛋白（HDL）和体质量的影响。方法：将176例精神分裂症患者分成氯氮平组（30例）、奥氮平组（30例）、奎硫平组（30例）、利培酮组（30例）、阿立哌唑组（30例）和齐拉西酮组（26例）,治疗6周。于治疗前和治疗6周测量空腹血糖、HbA1C、TG、HDL和体质量。结果：治疗前后血糖、HbA1C、TG、HDL和体质量在阿立哌唑组和齐拉西酮组无显著变化,氯氮平组和奥氮平组治疗后显著增高（P〈0.05或P〈0.01）;奎硫平组和利培酮组可引起体质量显著增加（P〈0.01）,但对血糖、HbA1C、TG、HDL影响不大。结论：阿立哌唑、齐拉西酮对精神分裂症患者代谢的影响较小,奎硫平、利培酮次之,氯氮平、奥氮平对患者代谢的影响最大。     

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。     

齐拉西酮与奎硫平对首发精神分裂症患者体质量及糖脂代谢影响的对照研究

目的:比较齐拉西酮与奎硫平对精神分裂症患者体质量、糖脂代谢的影响. 方法:将82例精神分裂症患者随机分为齐拉西酮组与奎硫平组,每组各41例,分别给予齐拉西酮和奎硫平治疗6个月.于治疗前和治疗6个月后分别测体质量、空腹血糖及血脂总胆固醇(CHo)、三酰甘油(TG)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)进行比较. 结果:齐拉西酮组治疗前后各项指标差异无统计学意义(P＞0.05),而奎硫平组治疗6个月后体质量、空腹血糖、CHO及TG显著升高(P＜0.05或P＜0.01). 结论:奎硫平可能对精神分裂症患者体质量、血糖及血脂有较多影响,而齐拉西酮影响较小.     

奥氮平对精神分裂症患者血脂、体质量的影响研究

目的探讨奥氮平对精神分裂症患者脂质代谢及体质量影响。方法采用自身对照方法，比较30例精神分裂症患者在奥氮平治疗第0、4、8、52周末的血脂水平及体质量变化。结果52周观察中，TC在第8周时达到高峰（p〈0.05）；TG在第52周时达到高峰，（p〈0．05）。HDL在第8周时达到低谷（p〈0．05）；LDL在整个52周各时间段中变化不明显（（p〉0．05））；体质量在第4～8周增长最快（p〈0．01），体质量的增长呈连续增长，第8周与52周比较无统计学意义，但标准差增大。从时间而言，第4周至8周与第8周至52周比较，血脂上升的速度前者较快（p〈0．05）。结论体质量增加以0～8周为重，高血脂症可能使血液流变学产生改变，HDL降低不能排除其它因素所致，LDL变化不明显，难以充分说明本药能导致粥样动脉硬化疾病。     

氨磺必利与奥氮平治疗老年期精神分裂症的临床疗效及对糖脂代谢影响的比较

目的 比较氨磺必利与奥氮平对老年期精神分裂症患者血糖和血脂代谢的影响。方法 60例老年期精神分裂症患者采用随机数字表法分为氨磺必利组（30例）和奥氮平组（30例）,分别给予氨磺必利片和奥氯平片口服,检测入纽时和治疗2,4,8周后两组空腹血糖（FBS）,总胆固醇（TC）,高密度脂蛋白（HDL）,低密度脂蛋白（LDL）,甘油三酯（TG）及体质量指数（BMI）,并评定入组时和治疗2,4,8周后两组的PANSS评分,治疗不良反应量表（TESS）评定不良反应。结果 氨磺必利组有效率82．8％,奥氮平组为86．2％,两组比较差异无统计学意义（U=0．118,P〉0．05）。两组患者治疗8周末PANSS总分及各量表评分差异无统计学意义（P〉0．05）。奥氮平组MBI,FBS,LDL,TC,TG随时间升高趋势明显,经重复测量方差分析,差异有统计学意义（P〈0．05）,而氨磺必利组内各时点各项指标变化不明显,差异无统计学意义（P〉0．05）。两组治疗8周末TESS评分氨磺必利组为（2．49±1．32）分,奥氮平组（2．95±1．56）分,两组比较差异有统计学意义（t=2．190,P=0．033）,氨磺必利组不良反应发生率低。结论 氨磺必利对老年期精神分裂症的疗效与奥氮平相当,但对患者血糖、血脂的影响明显小于奥氮平。     

氯丙嗪和阿立哌唑对精神分裂症患者血脂、血糖影响的对照分析

目的探讨氯丙嗪、阿立哌唑对精神分裂症患者治疗前、后的血脂、血糖的影响。方法对30例服用氯丙嗪和29例服用阿立哌唑的精神分裂症患者,在治疗前、治疗8周、16周后的血胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖的进行测定并分析。结果氯丙嗪组血胆固醇、甘油三酯治疗前、后有显著差异（P〈0．05）,低密度脂蛋白的治疗前、后有显著的差异（P〈0．05）,高密度脂蛋白、血糖治疗前、后变化无显著差异;阿立哌唑组治疗前、后血中胆固醇（TC）、甘油三酯（TG）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白、血糖均无显著差异。结论氯丙嗪可引起精神分裂症患者的脂类代谢异常,阿立哌唑对血脂、血糖的影响较小。     

奥氮平与阿立哌唑对首发精神分裂症糖脂代谢影响的对照研究

目的 研究阿立哌唑、奥氮平对首发精神分裂症患者血糖及血脂代谢的影响.方法 随机将61例首发精神分裂症患者分为奥氮平组和阿立哌唑组,比较治疗前及治疗后第6周末两组患者身高、体质量、血糖（FBG）、胰岛素（INS）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TG）、总胆固醇（TC）变化.结果 治疗后第6周末奥氮平组FBG、INS、IRI、LDL、TG、TC、体质量及BMI均较治疗前明显升高（P＜0.05,P＜0.01）,治疗后第6周末奥氮平组上述指标较阿立哌唑组高（P＜0.05）.结论 与奥氮平相比,阿立哌唑对首发精神分裂症患者FBG及血脂代谢影响较轻.     

奎硫平与奥氮平对精神分裂症患者生活质量影响的对照研究

目的比较奎硫平与奥氮平对精神分裂症患者的疗效及生活质量的影响。方法对60例精神分裂症患者，随机分为奎硫平组（30例）与奥氮平组（30例）治疗，疗程12周。分别于治疗前、4周、8周、12周末，采用阳性与阴性症状量表（PANSS）评定疗效，治疗中出现的症状量表（TESS）评定不良反应，于治疗前和12周末采用生活质量综合评定问卷（GQOLI-74）评定生活质量。结果两组均有显著疗效，奎硫平组与奥氮平组均可显著提高生活质量。两组间比较无统计学意义（P〉0．05）。奎硫平组主要不良反应为嗜睡，但两组间比较无显著差异；奥氮平组主要不良反应为体重增加、血糖升高，两组有统计学意义。结论奎硫平与奥氮平对精神分裂症疗效好，不良反应较少，均可提高患者生活质量。     

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。     

奎硫平与奥氮平对精神分裂症患者生活质量的影响

目的：观察奎硫平与奥氮平对精神分裂症患者生活质量的影响。方法：60例精神分裂症患者随机分为奎硫平组和奥氮平组,各30例。分别给予奎硫平和奥氮平治疗12周。采用阳性与阴性症状量表（PANSS）、生活质量综合评定问卷（GQOLI）及治疗中出现的症状量表（TESS）评定疗效及不良反应。结果：治疗后两组PANSS总分均明显下降（P〈0.01）;奎硫平组GQOLI总分及躯体健康维度中的躯体不适感、食与性功能、运动与感觉因子分均较治疗前显著增高（P均〈0.01）,与奥氮平组比较差异有统计学意义（P〈0.01）。两组TESS评分以奎硫平组（3.1±1.7）分明显低于奥氮平组（8.1±3.9）分（P〈0.01）。结论：奎硫平治疗精神分裂症疗效与奥氮平相仿,但更能提高患者的生活质量。     

齐拉西酮与奥氮平治疗首发精神分裂症对照研究

目的：探讨齐拉西酮与奥氮平治疗首发精神分裂症的临床疗效与安全性。方法：将64例首发精神分裂症患者随机分为齐拉西酮组32例与奥氮平组32例,治疗8周。采用阳性与阴性症状量表（PANSS）评定疗效,采用治疗中出现的症状量表（TESS）评定不良反应。结果：齐拉西酮组总有效率为84.4%,奥氮平组为87.5%,两组差异无显著性（P〉0.05）。齐拉西酮组主要不良反应是失眠,奥氮平组是体质量增加和血糖升高。结论：齐拉西酮与奥氮平治疗首发精神分裂症均有良好疗效,2药不良反应均较轻。     

The PsyCoLaus study: methodology and characteristics of the sample of a population-based survey on psychiatric disorders and their association with genetic and cardiovascular risk factors

Background

How long an antipsychotic is effective in maintaining response is important in choosing the correct treatment for people with schizophrenia. This post-hoc analysis describes maintenance of response over 24 or 28 weeks in people treated for schizophrenia with olanzapine, risperidone, quetiapine, ziprasidone, or aripiprazole.

Methods

This was a post-hoc analysis using data from 5 double-blind, randomized, comparative trials of 24 or 28 weeks duration in which olanzapine was compared to risperidone (1 study; N = 339), quetiapine (1 study; N = 346), ziprasidone (2 studies; N = 548 and 394) or aripiprazole (1 study; N = 566) for treatment of schizophrenia. For each study, time to loss of response in patients who met criteria for response at Week 8 and the proportion of patients who lost response following Week 8 were compared by treatment group. The number needed to treat (NNT) with olanzapine rather than comparator to avoid loss of one additional responder over 24 or 28 weeks of treatment was calculated for each study.

Results

Time maintained in response was significantly longer (p < .05) for olanzapine compared to risperidone, quetiapine, and ziprasidone. Olanzapine did not significantly differ from aripiprazole. The proportion of patients who lost response was significantly lower for olanzapine versus risperidone, quetiapine, and ziprasidone (p < .05). NNTs to avoid one additional patient with loss of response with olanzapine versus risperidone, quetiapine and ziprasidone were favourable, ranging from 5 to 9.

Conclusion

During 24 and 28 weeks of treatment, the antipsychotics studied differed in the time that treated patients with schizophrenia remained in response and the proportion of patients who lost response. Olanzapine treatment resulted in a consistent and statistically significant advantage in maintenance of response compared to treatment with risperidone, quetiapine and ziprasidone; but not compared to treatment with aripiprazole.     

奥氮平和奎硫平治疗首发精神分裂症对照研究

目的:比较奥氮平和奎硫平治疗首发精神分裂症的疗效和安全性。方法:将80例符合中国精神障碍分类与诊断标准第3版诊断标准的首发精神分裂症患者,随机平分为奥氮平组和奎硫平组各40例。疗程6周。采用阳性与阴性症状量表(PANSS)、副反应量表(TESS)评定疗效与不良反应。结果:奥氮平组阳性症状评分下降显著大于奎硫平组;两组阴性症状、一般精神病理症状和PANSS总分下降差异无显著性(P>0.05)。奥氮平组主要不良反应为体质量(体重)增加、肝功能损害和锥体外系症状;奎硫平组主要不良反应为嗜睡和头昏。结论:奥氮平对精神分裂症阳性症状的疗效优于奎硫平,两药不良反应均相对较轻。     

Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic

BACKGROUND: In the treatment of schizophrenia, changing antipsychotics is common when one treatment is suboptimally effective, but the relative effectiveness of drugs used in this strategy is unknown. This randomized, double-blind study compared olanzapine, quetiapine, risperidone, and ziprasidone in patients who had just discontinued a different atypical antipsychotic. METHOD: Subjects with schizophrenia (N=444) who had discontinued the atypical antipsychotic randomly assigned during phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) investigation were randomly reassigned to double-blind treatment with a different antipsychotic (olanzapine, 7.5-30 mg/day [N=66]; quetiapine, 200-800 mg/day [N=63]; risperidone, 1.5-6.0 mg/day [N=69]; or ziprasidone, 40-160 mg/day [N=135]). The primary aim was to determine if there were differences between these four treatments in effectiveness measured by time until discontinuation for any reason. RESULTS: The time to treatment discontinuation was longer for patients treated with risperidone (median: 7.0 months) and olanzapine (6.3 months) than with quetiapine (4.0 months) and ziprasidone (2.8 months). Among patients who discontinued their previous antipsychotic because of inefficacy (N=184), olanzapine was more effective than quetiapine and ziprasidone, and risperidone was more effective than quetiapine. There were no significant differences between antipsychotics among those who discontinued their previous treatment because of intolerability (N=168). CONCLUSIONS: Among this group of patients with chronic schizophrenia who had just discontinued treatment with an atypical antipsychotic, risperidone and olanzapine were more effective than quetiapine and ziprasidone as reflected by longer time until discontinuation for any reason.     

Comparative effectiveness of second-generation antipsychotic medications in early-onset schizophrenia

Scant information exists to guide pharmacological treatment of early-onset schizophrenia. We examine variation across commonly prescribed second-generation antipsychotic medications in medication discontinuation and psychiatric hospital admission among children and adolescents clinically diagnosed with schizophrenia. A 45-state Medicaid claims file (2001-2005) was analyzed focusing on outpatients, aged 6-17 years, diagnosed with schizophrenia or a related disorder prior to starting a new episode of antipsychotic monotherapy with risperidone (n = 805), olanzapine (n = 382), quetiapine (n = 260), aripiprazole (n = 173), or ziprasidone (n = 125). Cox proportional hazard regressions estimated adjusted hazard ratios of 180-day antipsychotic medication discontinuation and 180-day psychiatric hospitalization for patients treated with each medication. During the first 180 days following antipsychotic initiation, most youth treated with quetiapine (70.7%), ziprasidone (73.3%), olanzapine (73.7%), risperidone (74.7%), and aripirazole (76.5%) discontinued their medication (χ(2) = 1.69, df = 4, P = .79). Compared with risperidone, the adjusted hazards of antipsychotic discontinuation did not significantly differ for any of the 4-comparator medications. The percentages of youth receiving inpatient psychiatric treatment while receiving their initial antipsychotic medication ranged from 7.19% (aripiprazole) to 9.89% (quetiapine) (χ(2) = 0.79, df = 4, P = .94). As compared with risperidone, the adjusted hazard ratio of psychiatric hospital admission was 0.96 (95% CI: 0.57-1.61) for olanzapine, 1.03 (95% CI: 0.59-1.81) for quetiapine, 0.85 (95% CI: 0.43-1.70) for aripiprazole, and 1.22 (95% CI: 0.60-2.51) for ziprasidone. The results suggest that rapid antipsychotic medication discontinuation and psychiatric hospital admission are common in the community treatment of early-onset schizophrenia. No significant differences were detected in risk of either adverse outcome across 5 commonly prescribed second-generation antipsychotic medications.     

Long-term neurocognitive effects of olanzapine or low-dose haloperidol in first-episode psychosis.

BACKGROUND: Neurocognitive deficits are severe in first-episode psychosis. METHODS: Patients (N = 263) with first-episode psychosis (schizophrenia, schizoaffective, or schizophreniform disorders) were randomly assigned to double-blind treatment with olanzapine (mean 11.30 mg/day) or haloperidol (mean 4.87 mg/day) for 104 weeks. A neurocognitive battery was administered at baseline (n = 246) and 12 (n = 167), 24 (n = 126), 52 (n = 89), and 104 (n = 46) weeks during treatment. Weighted principal component and unweighted composite scores were derived from individual tests. RESULTS: Both treatment groups demonstrated significant improvement on both composite scores. On the basis of the weighted composite score, olanzapine had greater improvement than haloperidol only at 12 (p = .014) and 24 (p = .029) weeks. For the unweighted composite, olanzapine had significantly better improvement compared with haloperidol only at week 12 (p = .044). At week 12 only, olanzapine improved performance on the Digit Symbol and Continuous Performance Test significantly more than haloperidol. CONCLUSIONS: Both antipsychotic agents appeared to improve neurocognitive functioning among first-episode psychosis patients with schizophrenia. A significantly greater benefit in terms of neurocognitive improvement was found with olanzapine than with haloperidol at weeks 12 and 24.     

奥卡西平辅助治疗精神分裂症及分裂样精神病兴奋躁动的比较研究

目的评估奥卡西平治疗兴奋躁动精神分裂症、分裂样精神病辅助疗效和安全性。方法将符合中国精神障碍分类与诊断标准第3版中精神分裂症、分裂样精神病诊断标准,并以兴奋躁动为主要表现的80例患者随机分为研究组(n=39)和对照组(n=41),研究组应用抗精神病药物(氯氮平、奥氮平、利培酮、喹硫平、阿立哌唑或齐拉西酮其中之一)联合奥卡西平,对照组单一使用抗精神病药物,观察6周。采用简明精神病量表(BPRS)和阳性和阴性综合征量表(PANSS)兴奋因子,不良反应量表(TESS)在治疗前及治疗后第1,2,4,6周分别评估疗效和安全性。结果治疗6周后,研究组有效28例(71.8%),对照组有效26例(65.0%),2组有效率差异有统计学意义(χ2=6.02,P=0.028)。研究组与对照组患者分别脱落2例和4例。研究组的主要不良反应为镇静(11例)、便秘(10例)、头晕(7例)、心动过速(7例)等,对照组的主要不良反应为便秘(14例)、口干(12例)、心动过速(12例)、锥体外系不良反应(7例)等。结论奥卡西平能有效辅助治疗精神分裂症、分裂样精神病的兴奋状态。     

齐拉西酮与奥氮平治疗精神分裂症对照研究

目的：探讨齐拉西酮与奥氮平治疗精神分裂症的疗效及安全性。方法：共59例精神分裂症，分别以齐拉西酮（30例）及奥氮平（29例）治疗。采用阳性与阴性症状量表（PANSS）、治疗中出现的症状量表（TESS）评定疗效及不良反应。结果：齐拉西酮组有效率为80．0％，显效率为63．3％，与奥氮平组相当，对阴性症状疗效优于奥氮平组。结论：齐拉西酮治疗精神分裂症疗效较好，不良反应较少。     

齐拉西酮治疗老年期首发精神分裂症的疗效及对糖、脂代谢的影响

背景:随着我国人口老龄化的出现,老年期首发精神分裂症有逐渐增多趋势,合理选择治疗药物成为一个值得关注的问题.目的:探讨齐拉西酮治疗老年期首发精神分裂症的临床疗效及其对糖、脂代谢指标的影响.方法:采用区组随机化分组,将38例老年期首发精神分裂症患者随机分为齐拉西酮治疗组(研究组)与奥氮平治疗组(对照组)各19例.分别于治疗前、4周末、8周末、12周末采用阳性与阴性症状量表(PANSS)评定疗效,副反应量表(TESS)评定药物不良反应.同时测量空腹血糖(FBG)及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-c).结果:两组PANSS评分4周、8周、12周末均无显著差异,两组疗效相当.重复测量方差分析显示治疗期间研究组与对照组的空腹血糖(FBG)(Ftime×group=7.539,p=0.001)及总胆固醇(TC)(Ftime×group=32.194,p<0.001)、甘油三酯(TG)(Ftime×group=488.312,p<0.001)、低密度脂蛋白(LDL-c)(Ftime×group=9.380,p<0.001)均有显著性差异.结论:齐拉西酮治疗老年期精神分裂症疗效确切,对糖、脂代谢影响较小,适合老年患者长期服用.