利培酮治疗儿童精神分裂症对照研究

目的：比较利培酮和氟哌啶醇治疗儿童精神分裂症的疗效和不良反应。方法：42例儿童精神分裂症患者随机分为利培酮组和氟哌啶醇组，治疗6周。用简明精神病评定量表(BPRS)和副反应量表(TESS)评定疗效和不良反应。结果：利培酮组和氟哌啶醇组BPRS总分在治疗末均显著下降，两组间BPRS总分差异无显著性；两组间疗效差异亦无显著性；利培团组不良反应发生率比氟哌啶醇组明显为低。结论：利培酮治疗儿童精神分裂症安全有效，可作为治疗儿童精神分裂症的首选药物。     

利培酮口服液治疗精神分裂症急性期对照研究

目的 探讨利培酮口服液治疗精神分裂症急性期的疗效和副作用.方法 以利培酮口服液与氟哌啶醇治疗精神分裂症急性期各30例作对照研究,采用简明精神症状量表（BPRS）及其各单项评分,不良反应量表（TESS）评定疗效及副反应.结果 利培酮组及氟哌啶醇组在入院后3 d临床疗效一致,无显著性差别（P＞0.05）,疗程30 d后利培酮口服液有效率93%,显效率73%,氟哌啶醇组有效率86%,显效率36%.利培酮口服液药物副反应明显较氟哌啶醇少（P＜0.01）.结论 两种药对治疗精神分裂症急性期均有确切疗效.利培酮口服液对症状的改善效果更好,两组BPRS总分：利培酮口服液组减分率P＜0.001,氟哌啶醇组减分率P＜0.01,两组药物总体疗效有显著性差异（P＜0.01）,且服药依从性好.     

首发青少年精神分裂症药物疗效的纵向比较

目的　了解利培酮、氯氮平、氯丙嗪、氟哌啶醇 4种抗精神病药物治疗首发青少年精神分裂症患者的近期和远期疗效。方法　将首发青少年精神分裂症 2 36例分成利培酮组、氯氮平组、氟哌啶醇组及氯丙嗪组 ,采用BPRS及TESS在患者首次住院治疗前及治疗后 2、4、6、8周进行评定 ,并观察 4组药物的副反应 ;对 4组患者出院后 3年内进行随访 ,并利用BPRS、TESS及SDSS每年评定 1次。结果　在首次住院中 ,4种抗精神病药物在治疗精神分裂症症状方面的近期疗效基本相同 ,但在药物副作用方面 4组患者有显著差异 ;在 3年随访中 ,4组患者在中断治疗、社会功能恢复等方面也有显著差异。结论　非典型抗精神药物的远期疗效优于典型抗精神病药物 ,提示在治疗青少年精神分裂症患者时可首选利培酮或氯氮平等非典型抗精神病药物     

利培酮、氯氮平和氟哌啶醇治疗精神分裂症的疗效比较结果

目的　比较利培酮、氯氮平和氟哌啶醇的疗效和不良反应。方法　将符合CCMD - 2 -R诊断标准的精神分裂症患者 ,根据入院顺序分别进入利培酮组、氯氮平组和氟哌啶醇组 ,并观察 8周。以PANSS和TESS量表评定药物的疗效和不良反应。结果　利培酮组、氯氮平组和氟哌啶醇组的PANSS量表总分、阴性分量表、一般精神病理学分量表评分均下降 ;利培酮组和氯氮平组减分较氟哌啶醇组明显 (分别P <0 0 1,P <0 0 5 ) ,TESS量表的评分也与氟哌啶醇组有显著性差异 (分别P <0 0 1,P <0 0 5 ) ;利培酮组、氯氮平组和氟哌啶醇组肝功能、心电图检查结果 ,组间差异有非常显著意义 (P <0 0 1) ;利培酮组不良反应少于氯氮平组和氟哌啶醇组。结论　利培酮、氯氮平和氟哌啶醇均具有较强的抗精神病作用 ,利培酮的安全性相对较好。     

氟哌啶醇、利培酮及齐拉西酮对精神分裂症患者血清催乳素及认知功能影响的对照研究

目的 探讨氟哌啶醇、利培酮及齐拉西酮对精神分裂症患者血清催乳素及认知功能的影响.方法 选取精神分裂症患者120例,随机分为3组,分别予以氟哌啶醇、利培酮、齐拉西酮进行干预治疗.于治疗前及治疗后第4、8、12周末分别进行阳性和阴性综合征量表（PANSS）、精神分裂症认知功能评定量表（SCoRS）评定,并测定血清催乳素（PRL）水平.结果 （1）3组PANSS评分治疗后各时点均较治疗前下降（P＜0.01）.（2）3组患者各时点男性PRL水平均较治疗前升高（P＜0.01）,治疗后12周末齐拉西酮组PRL水平低于利培酮组（P＜0.05）;女性患者中氟哌啶醇组从第8周始、利培酮组从第4周始,PRL水平均较治疗前升高（P＜0.05）,治疗后第12周末齐拉西酮组PRL水平均低于氟哌啶醇组与利培酮组（P＜0.05）.（3）3组患者治疗后各时点SCoRS评分较治疗前下降（P＜0.01）,治疗后各时点SCoRS评分齐拉西酮组低于氟哌啶醇组（P＜0.05,P＜0.01）.结论 氟哌啶醇、利培酮、齐拉西酮均可造成催乳素水平增高.齐拉西酮影响相对较小,对女性患者催乳素水平影响更小.利培酮、齐拉西酮对患者认知功能改善显著优于氟哌啶醇.     

抗精神病药对老年精神分裂症患者血清催乳素的影响

目的：探讨几种抗精神病药对老年精神分裂症患者血清催乳素（PRL）的影响。方法：随机选取抗精神病药治疗老年精神分裂症患者121例，分别在治疗前后测定血清PRL水平。结果：患者经舒必利、奋乃静、氟哌啶醇和利培酮治疗后血清PRL明显升高，各药物之间以及治疗前后比较差异均有显著性（F=15．95，P〈0．01）。PRL水平的升高与药物剂量呈正相关。氯氮平对PRL水平影响不明显。结论：典型和非典型抗精神病药对老年精神分裂症患者血清PRL水平的影响同样明显，强弱的顺序依次是舒必利、奋乃静、氟哌啶醇和利培酮。     

抗精神病药物治疗抽动障碍有效性和安全性的Meta分析

目的 本研究采用Meta 分析的方法,评估各种抗精神病药物治疗抽动障碍的有效性和安 全性。方法 计算机检索Cochrane 图书馆、PubMed、EMBASE 中国生物医学文献数据库（CBM）、中国期 刊全文数据库（CNKI）、中国科技期刊全文数据库（VIP）、万方数据库,并查看纳入文献清单和相关系统评 价的参考文献,全面收集抗精神病药物治疗抽动障碍的随机对照试验（RCT）,对研究结果进行Meta分析, 采用Stata 软件进行统计分析。结果 纳入60 项研究,涉及4 077 例患者,年龄2～65 岁,研究论文发表 时间为1978—2015 年。各研究的样本量为4～180 例（中位数为61 例）。改善抽动症状评分方面,利培 酮比氟哌啶醇（P=0.54）、阿立哌唑比氟哌啶醇（P=0.45）、盐酸硫必利比氟哌啶醇（P=0.52）、氟哌啶醇比哌 咪清（P=0.67）、奥氮平比氟哌啶醇（P=0.15）、哌咪清比安慰剂（P=0.06）,组间差异均无统计学意义。喹硫 平优于氟哌啶醇,阿立哌唑优于盐酸硫必利,利培酮和氟哌啶醇优于安慰剂（P均＜ 0.05）,组间差异有统 计学意义。42 项研究报道了不良反应,非典型抗精神病药物耐受性较好,无严重不良反应。结论 典 型抗精神病药物能治疗抽动症状,效果明显,但不良反应较多,临床应用受到限制;非典型性抗精神病 药物（利培酮、阿立哌唑、奥氮平、齐拉西酮、喹硫平）能有效改善抽动症状,且耐受性较好,其中利培酮 和阿立哌唑是研究证据相对充足的有效药物,喹硫平是具有较好前景的药物,齐拉西酮、奥氮平与喹硫 平有一定疗效,但研究证据较缺乏。抗精神病药物的远期疗效和安全性有待高质量的研究来证实。     

阿立哌唑治疗闭经的女性精神分裂症患者

抗精神病药物所致女性闭经作为继发性闭经,是抗精神病药治疗中常见的不良反应。我们汇集了用阿立哌唑替换利培酮或氟哌啶醇治疗的青年女性精神分裂症闭经患者的临床资料,报道如下。     

利培酮治疗老年精神分裂症患者对照研究

目的 :评价利培酮和氟哌啶醇治疗老年精神分裂症患者的疗效和安全性。　方法 :对 10 5例老年精神分裂症患者分别给予利培酮、氟哌啶醇治疗 ,其中利培酮组 5 4例 ,氟哌啶醇组 5 1例。疗程12周。以简明精神病评定量表 (BPRS)评定临床疗效 ,以副反应量表 (TESS)和实验室检测评价安全性。　结果 :治疗结束时 ,两组BPRS总分较治疗前显著降低 (P <0 0 1) ,两组间差异无显著性 ,两组临床疗效 ,利培酮组有效率 87 0 % ,显效率 5 7 4 %。氟哌啶醇组有效率 84 3% ,显效率 5 4 9% ,两组差异无显著性。利培酮组不良反应总发生率较氟哌啶醇组少 (P <0 0 5 )。　结论 :利培酮治疗老年精神分裂症患者的疗效与氟哌啶醇相似 ,不良反应较氟哌啶醇轻而少。     

奎硫平与氟哌啶醇治疗精神分裂症兴奋激越症状的对照研究

目的 比较奎硫平与典型抗精神病药氟哌啶醇治疗精神分裂症病人伴有兴奋激越的疗效与不良反应。方法 符合CCMD-3诊断标准的精神分裂症住院患者，采用随机对照、开放性研究治疗21天。以阳性与阴性症状量表（PANSS）评估疗效，以副反应量表（TESS）评估不良反应。统计学检验采用t检验和非参数检验。结果 奎硫平组40例，氟哌啶醇组30例。1．奎硫平与氟哌啶醇的总体疗效（t=1．815）、兴奋症状的控制（t=0．478）效果相当（P〉0．05）。2．不良反应方面：氟哌啶醇引起的椎体外系不良反应如肌强直、静坐不能较奎硫平高。结论 奎硫平合并氯硝西泮对精神分裂症兴奋症状的疗效与典型抗精神病药物氟哌啶醇相当，不良反应较小。     

Risperidone-induced increase of plasma norepinephrine is not correlated with symptom improvement in chronic schizophrenia.

BACKGROUND: Previous studies have shown an increase in plasma levels of norepinephrine (NE) after clozapine treatment of schizophrenia. This effect has been suggested to relate to improvement in symptoms. METHODS: To test whether other novel antipsychotic drugs have such an effect, the present experiment examined schizophrenic symptoms and plasma levels of NE before and after 5 weeks of treatment with risperidone or haloperidol. RESULTS: Risperidone, but not haloperidol, significantly increased plasma NE; however, there was no correlation of this effect with clinical improvement on any symptom scale. CONCLUSIONS: This finding suggests that risperidone shares similar properties with clozapine in enhancing peripheral NE, but that these changes in plasma NE may not be a consistent indicator of atypical antipsychotic drug efficacy.     

Subjective experiences on antipsychotic medications: synthesis and conclusions

OBJECTIVE: This report synthesizes the literature describing the phenomenology, clinical importance and biology of subjective responses to antipsychotic medications in schizophrenia. A patient's experience of an antipsychotic is important because unpleasant or dysphoric responses can impair therapeutic relationships, lead to medication non-adherence, and have direct negative effects on a patient's quality of life. METHOD: The author selectively reviewed early studies of subjective responses to antipsychotics and integrated this literature with the work of the other investigators in this special section. RESULTS: There is substantial evidence that second-generation antipsychotics have advantages in causing fewer dysphoric responses when compared with first-generation agents. Clinical and neuroimaging studies suggest that dopamine blockade is an important determinant of many of these dysphorias. At this point in time it is unclear whether dysphoria results from extrapyramidal symptoms--particularly akathisia and akinesia--or whether they are a direct result of decreased dopamine activity. CONCLUSION: Clinicians and researchers should continue to monitor dysphorias in schizophrenia. Contributions by the authors in this supplement provide new and more refined methods for measuring subjective responses in future studies.     

Double-blind, placebo-controlled, multicenter trial of selegiline augmentation of antipsychotic medication to treat negative symptoms in outpatients with schizophrenia

OBJECTIVE: The authors' goal was to test the efficacy of selegiline augmentation of antipsychotic medication in outpatients with schizophrenia who had negative symptoms of moderate or greater severity. METHOD: A 12-week, double-blind, placebo-controlled, multicenter trial of oral selegiline augmentation of antipsychotic medication was carried out. Outpatients were chosen who did not manifest severe positive symptoms at baseline, who did not meet criteria for coexisting major depression, and who had been maintained on a stable regimen of antipsychotic medication. RESULTS: Negative symptoms were found to be significantly more improved in the patients who received selegiline, and global improvement scores reinforced the impression that selegiline augmentation was beneficial. CONCLUSIONS: These findings support further investigation of low-dose selegiline augmentation of antipsychotic medication in outpatients with schizophrenia who have at least a moderate burden of negative symptoms.     

Information processing deficits in acutely psychotic schizophrenia patients medicated and unmedicated at the time of admission

OBJECTIVE: In patients with schizophrenia, information processing deficits, such as those reported in studies that measured prepulse inhibition of the human startle response and habituation of startle magnitude, may be improved with atypical antipsychotic treatment. However, it remains unclear whether antipsychotic medication is directly responsible for the improvement or whether differences in prepulse inhibition reflect other factors, such as acuity status. The present study investigated the effects of antipsychotics on prepulse inhibition and startle habituation in acutely hospitalized patients with schizophrenia. METHOD: Forty-one acutely psychotic schizophrenia patients (21 who were unmedicated at the time of admission and 20 who had been receiving antipsychotic treatment) were tested within 72 hours of hospital admission. Thirteen healthy subjects were also studied for comparative purposes. Primary dependent measures were startle responsivity, reactivity, prepulse inhibition, and startle habituation. RESULTS: Schizophrenia patients, whether medicated or unmedicated at admission, showed prepulse inhibition deficits compared with healthy subjects and did not statistically differ from each other in startle magnitude, prepulse inhibition, or habituation. There was a higher number of startle "nonresponders" among those who had been receiving medication versus those unmedicated at the time of admission. CONCLUSIONS: The present findings suggest that antipsychotic effects on prepulse inhibition may not be evident at a time when schizophrenia patients are acutely symptomatic. These results suggest that the neurobiological substrate underlying prepulse inhibition deficits may be dysregulated during acute psychotic states while the patients are in early phases of medication treatment.     

Tardive dyskinesia and deficit schizophrenia

Telfer S, Shivashankar S, Krishnadas R, McCreadie RG, Kirkpatrick B. Tardive dyskinesia and deficit schizophrenia. Objective: Despite comparable antipsychotic exposure, some patients experience involuntary movements yet others do not. Negative symptoms have been associated with tardive dyskinesia (TD), but it is not certain whether this is an association with primary negative symptoms or the effects of medications. The aim of the present study was to determine whether patients with deficit schizophrenia (who have primary negative symptoms) are more likely to experience TD than those with non‐deficit schizophrenia. Method: In 2006, all the people with a clinical diagnosis of schizophrenia in Nithsdale, Southwest Scotland, were identified using the ‘key informant’ method. These patients were categorized into those with and without the deficit syndrome and assessed for the presence of TD. Patients were also assessed for akathisia and extrapyramidal side effects. Results: Of the 131 people assessed, 31 were categorized as having deficit schizophrenia (23.7%) and 100 people (76.3%) as non‐deficit. There was no difference between the two groups with regard to age, antipsychotic exposure, and duration of illness. There was a significant association between deficit features and TD with an odds ratio = 2.97 [95% CI 1.128–6.88, P = 0.009]. Conclusion: Our findings support the proposal that the pathological process underlying deficit schizophrenia can predispose to the development of TD.     

Normal P50 suppression in schizophrenia patients treated with atypical antipsychotic medications

OBJECTIVE: Patients with schizophrenia have deficits in attention, cognition, and information processing. Measures such as P50 suppression are used to study cognitive and attentional dysfunction among these patients. P50 suppression is an operational measure of sensory gating that can be assessed by averaging electroencephalographic responses to multiple pairs of auditory clicks separated by 500 msec. Normally, the P50 response to the second click is smaller than the response to the first click. Many studies have demonstrated that schizophrenia patients have deficient P50 suppression, meaning that the difference between the first and second clicks is not as large as normal. Atypical antipsychotic medications may have superior clinical efficacy for negative symptoms and cognitive deficits. It is important, therefore, to evaluate the effects of atypical antipsychotic medications on measures such as P50 suppression. METHOD: P50 suppression of 13 patients with schizophrenia receiving clinically effective doses of clozapine, olanzapine, or risperidone (classified as atypical antipsychotic medications) was compared to that of 13 patients receiving conventional antipsychotic medications. RESULTS: The patient groups did not differ on clinical or demographic measures. The patients receiving atypical antipsychotic medications had normal-range P50 suppression (mean=72%). In contrast, the patients receiving typical antipsychotic medications had dramatically lower P50 suppression (mean=27%). CONCLUSIONS: The results support the hypothesis that patients treated with atypical antipsychotic medications have normal P50 measures of sensory gating. Longitudinal within-subjects studies are warranted to clarify the mechanisms mediating this effect.     

Influence of antipsychotic medication on pain perception in schizophrenia

A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of antipsychotic medication on the patients' responses. We investigated 23 schizophrenic subjects who had been not received antipsychotic treatment for 8 weeks, and we then reassessed them 3 days later after the introduction of neuroleptics. Acute symptoms of schizophrenia were measured using the Scales for the Assessment of Positive and Negative Symptoms. Thresholds were determined by a contact thermode on both volar wrists. Schizophrenic patients showed significantly increased thresholds of WP and TPO relative to healthy controls. Antipsychotics did not alter pain thresholds. We found no correlation between pain perception and psychometric scales. Our findings demonstrate altered warmth and heat pain perception in acute schizophrenia. We believe that our findings can be attributed to information-processing abnormalities of the disorder and that they are not specific to pain processing, per se, since both WP and TPO were significantly different. Future studies should evaluate attentional deficits in schizophrenia in relation to pain perception.     

Peripheral Amino Acid Levels in Schizophrenia and Antipsychotic Treatment

Abnormal levels of amino acids have been reported in patients with schizophrenia and have also been investigated as a biomarker to monitor antipsychotic treatment, however results have been inconsistent. The purpose of the present review is to summarize the evidence in the literature of whether amino acid levels can be a biomarker and predict the treatment outcome in schizophrenia. The current review does not support amino acid concentration as a useful biomarker for monitoring antipsychotic response in patients with schizophrenia, although there is evidence that high levels of serum homocysteine and glutamate might be considered as a trait marker for schizophrenia. This review has also highlighted a considerable dearth of studies, specifically of studies evaluating antipsychotic side-effects.     

Serum monitoring of antipsychotic drug levels during concomitant administration of sertraline and antipsychotic medication.

OBJECTIVE: To assess whether pharmacokinetic drug interactions occur when sertraline is added to antipsychotic medications. METHOD: Forty-eight patients with remitted DSM-IV schizophrenia and comorbid major depression were randomized to placebo for 6 weeks or sertraline 50 mg for 4 weeks followed by sertraline 50 mg to 100 mg for 2 weeks for nonresponders. Treatment with the patients' usual antipsychotic continued. Weekly clinical outcome assessments occurred for 6 weeks, and serum samples for drug monitoring were collected at Weeks 1, 5, and 6. Serum concentrations of sertraline and antipsychotics were measured with standard assays. RESULTS: In both placebo- and sertraline-treated groups, most patients displayed minor fluctuations in antipsychotic serum levels over 6 weeks. There was no clinical evidence of drug interactions in the sertraline-treated group. CONCLUSIONS: Clinically significant adverse effects did not occur despite variable antipsychotic serum levels with or without sertraline. Concern about pharmacokinetic interactions should not deter the use of sertraline for depression in individuals with schizophrenia.     

Antipsychotic drug treatment in the prodromal phase of schizophrenia

OBJECTIVE: The safety and tolerability of short-term treatment with a low dose of risperidone was evaluated in adolescents with prodromal symptoms and a family history of schizophrenia. METHOD: Four prodromal high-risk adolescents and six first-episode patients with schizophrenia were treated with average doses of 1.0 and 1.8 mg/day of risperidone, respectively, in an 8- to 12-week open-label trial. RESULTS: No significant treatment-related adverse events were noted. Severity of thought and behavior disturbance ratings declined by about 30%; performance on a test of verbal learning improved by about 100% during treatment in both prodromal and first-episode patients, changes that achieved statistical significance despite the small group sizes. CONCLUSIONS: These findings are preliminary and should not be used to guide health care decisions at this time. Randomized controlled trials are needed to determine whether antipsychotic drug treatment of prodromal patients can delay or prevent onset or attenuate the clinical course of schizophrenia.