齐拉西酮和奥氮平治疗精神分裂症的疗效及对认知功能的影响

目的探讨齐拉西酮和奥氮平治疗精神分裂症的疗效及对认知功能的影响。方法选取住院治疗的精神分裂症患者76例,随机分为观察组与对照组。观察组患者予齐拉西酮片治疗,先予以20 mg/d,2周内逐渐加至维持量80~160 mg/d;对照组患者予以奥氮平片治疗,先予5 mg/d,2周内逐渐加至维持剂量10~20 mg/d。两组疗效均为8周。观察两组患者治疗前与治疗8周后认知功能指标的变化,并比较其临床疗效和安全性。结果治疗8周后,两组患者MMSE评分和WMS评分较治疗前明显上升(P0.05或P0.01),且观察组患者上升幅度较对照组更明显(P0.05);同时观察组患者临床总有效率明显优于对照组(χ~2=4.15,P0.05);观察组患者TESS评分为(3.47±0.76)分,明显低于对照组的(4.47±0.89)分。两组患者治疗期间血尿常规、肝肾功能及心电图均无明显异常变化。结论齐拉西酮和奥氮平治疗精神分裂症能明显改善其认知功能,具有良好的临床效果及安全性,且前者改善认知功能及临床效果更佳,安全性较高。     

Acute massıve pulmonary embolism assocıated wıth olanzapıne

Treatment with low-potency anti-psychotic agents is an important risk factor in the development of pulmonary embolism (PE). We report a case of 74 years old female patient receiving olanzapine for psychotic depression admitted to the emergency service with the complaints of chest pain and shortness of breath. She had tachypnea, hypotension and tachycardia. Arterial blood gas analysis showed hypoxemia-hypocapnia and D-dimer level was high. Computed tomographic pulmonary angiography (CTPA) demonstrated pulmonary embolism in both main pulmonary arteries, through lobar and segmental branches. Tissue plasminogen activator (t-PA) was administered in intensive care unit. As the only possible risk factor for PE was olanzapine, olanzapine treatment was terminated with pyschiatry consultation. During the 12-month follow-up of the patient; malignancy was not observed. Diagnosis and prevention of PE are the important goals to reduce morbidity and mortality in subjects receiving olanzapine.     

氨磺必利与奥氮平治疗女性精神分裂症患者的对照研究

目的 比较氨磺必利与奥氮平治疗女性精神分裂症患者的疗效及安全性.方法 采用随机、单盲对照的方法,将100例女性精神分裂症患者随机均分为2组(n=50),分别使用氨磺必利(氨磺必利组)和奥氮平(奥氮平组)治疗8周,采用阳性症状与阴性症状(PANSS)量表评定疗效,采用副反应(TESS)量表评定不良反应.结果 经过8周治疗,氨磺必利组和奥氮平组显效率分别为76.6%和72.9%,2组疗效差异无统计学意义(U=0.167,P>0.05);但治疗4周末氨磺必利组阴性症状分较奥氮平组减少更显著(P<0.05).而氨磺必利和奥氮平组的不良反应发生率分别为38.3%和45.8%,差异无统计学意义,但奥氮平组嗜睡和体质量增加指标显著高于氨磺必利组,差异具有统计学意义(P<0.05),其他不良反应发生率差异无统计学意义.结论 氨磺必利是一种安全有效的抗精神病药,较适合女性精神分裂症患者的临床治疗.     

奥氮平与利培酮治疗精神分裂症抑郁症状的比较研究

目的:对照比较奥氮平与利培酮对精神分裂症抑郁症状的疗效。方法:66例精神分裂症伴抑郁症状的患者随机分为奥氮平组和利培酮组,各33例,均治疗8周,分别于治疗前和治疗后2、4、6、8周以阳性与阴性症状量表(PANSS)及汉密尔顿抑郁量表(HAMD)评定临床疗效;以治疗中出现的症状量表(TESS)评定不良反应,并体格检查及实验室检查,记录不良事件的发生。结果:治疗后两组患者PANSS和HAMD评分均显著下降,奥氮平组优于利培酮组,两组发生不良反应率无显著差异。结论:奥氮平治疗精神分裂症抑郁症状疗效优于利培酮疗效。     

奥氮平与阿立哌唑治疗老年期痴呆患者精神行为症状的对照研究

目的:探讨奥氮平与阿立哌唑对老年期痴呆精神行为症状的疗效及不良反应。方法:将68例老年期痴呆伴BPSD患者随机分为奥氮平组与阿立哌唑组,治疗8周。于治疗前,治疗2、4、8周末以痴呆病理行为评定量表(BEHAVE-AD)评定疗效,以简易智力状态检查表(MMSE)和日常生活能力量表(ADL)评定患者痴呆状况,以治疗中出现的症状量表(TESS)评定不良反应。结果:两组患者治疗后BEHAVE-AD评分显著减少(P<0.01),MMSE评分与治疗前比较无显著性差异(P>0.05),ADL有明显改善(P<0.05),两组间比较差异无显著性(P>0.05);两组患者不良反应均较轻微,不良反应总发生率在两组之间无统计学差异(P>0.05)。结论:奥氮平和阿立哌唑治疗老年期痴呆精神行为症状疗效均确切,起效快,不良反应少。     

奥氮平与利培酮治疗冰毒所致精神障碍的疗效

目的 探讨奥氮平与利培酮治疗冰毒所致精神障碍的效果。方法 冰毒所致精神障碍患者100例,采用双盲分组法将其分为观察组与对比组,各50例。对比组患者使用利培酮治疗,观察组患者使用奥氮平治疗,对比分析两组治疗前后阳性和阴性症状量表(PANSS)评分和治疗效果。结果 治疗后,观察组一般精神病理评分(19.52±6.32)分、阴性症状评分(14.42±4.25)分均低于对比组的(25.14±6.54)、(16.98±4.18)分,阳性症状评分(56.28±12.71)分高于对比组的(51.16±11.69)分,差异有统计学意义(P<0.05)。观察组治疗总有效率为94.00%,高于对比组的80.00%,差异有统计学意义(P<0.05)。结论 奥氮平治疗冰毒所致精神障碍效果更佳,具有较好的临床应用价值。     

DSM-5 mixed specifier for manic episodes: Evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data

Background

To describe the frequency of mixed specifier as proposed in DSM-5 in bipolar I patients with manic episodes, and to evaluate the effect of mixed specifier on symptom severity and treatment outcome.

Methods

This post-hoc analysis used proxies for DSM-5 mixed features specifier by using MADRS or PANSS items.

Results

Of the 960 patients analysed, 34%, 18% and 4.3% of patients, respectively, had ≥3 depressive features with mild (score ≥1 for MADRS items and ≥2 for PANSS item), moderate (score ≥2 MADRS, ≥3 PANSS) and severe (score ≥3 MADRS, ≥4 PANSS) symptoms. In patients with ≥3 depressive features and independent of treatment: MADRS remission (score ≤12) rate decreased with increasing severity (61–43%) and YMRS remission (score ≤12) was similar for mild and moderate patients (36–37%), but higher for severe (54%). In asenapine-treated patients, the MADRS remission rate was stable regardless of baseline depressive symptom severity (range 64–67%), whereas remission decreased with increasing severity with olanzapine (63–38%) and placebo (49–25%). Reduction in YMRS was significantly greater for asenapine compared with placebo at day 2 across the 3 severity cut-offs and continued to decrease throughout the treatment period. The difference between olanzapine and placebo was statistically significant in mild and moderate patients.

Limitations

Results are from post-hoc analyses.

Conclusions

These analyses support the validity of proposed DSM-5 criteria. They confirm that depressive features are frequent in bipolar patients with manic episodes. With increasing baseline severity of depressive features, treatment outcome was poorer with olanzapine and placebo, but remained stable with asenapine.     

奥氮平致呃逆1例

本文目的是通过报道1例奥氮平致呃逆,以引起临床医生对此不良反应的关注。1例47岁的男性癫痫性精神障碍患者,既往无重大躯体疾病史及呃逆病史,在接受丙戊酸钠缓释片及卡马西平治疗基础上,加用奥氮平10 mg/d,4天后出现持续性呃逆,停用奥氮平2天后,呃逆消失。再次应用奥氮平7天后又出现持续性呃逆,停用奥氮平2天后,呃逆又消失,期间丙戊酸钠缓释片及卡马西平剂量未变,提示系奥氮平所致呃逆。本案例提示临床上在应用奥氮平时,应考虑到引起呃逆的可能性。     

帕利哌酮缓释片治疗精神分裂症临床疗效和安全性

目的评价帕利哌酮缓释片治疗精神分裂症的疗效及安全性。方法将60例符合CCMD-3诊断标准的精神分裂症患者随机分为两组,分别给予帕利哌酮缓释片和奥氮平片治疗8周。采用阳性与阴性症状量表(PANSS)、临床疗效总评量表(CGI)及治疗中出现的症状量表(TESS)评定疗效及不良反应。结果治疗结束时,两组总分及各因子分均较治疗前有显著减低(P<0.01);帕利哌酮缓释片组临床总有效率为90.0%,奥氮平组为93.3%;两组间比较差异无显著性;帕利哌酮缓释片组不良反应发生率33.3%,奥氮平组的不良反应发生率49.5%。两组间比较差异无显著性。结论帕利哌酮缓释片治疗精神分裂症的疗效与奥氮平相似,不良反应少而轻。     

高剂量奥氮平治疗难治性精神分裂症的疗效

目的 探讨高剂量奥氮平治疗难治性精神分裂症的临床疗效,并观察其安全性及不良反应.方法 37例难治性精神分裂症患者被随机分为奥氮平组和氯氮平组,奥氮平组:奥氮平20～40mg/d治疗,氯氮平组:氯氮平200～500mg/d治疗.分别于治疗前、治疗4周、8周、12周应用阳性和阴性症状量表(PANSS)评定临床疗效,采用不良反应量表(TESS)、体格检查、实验室检查、心电图、脑电图评价安全性.结果 奥氮平组和氯氮平组PANSS总分及各因子分在治疗4周、8周、12周均显著下降(F=16.456,31.352,13.434,22.277,16.869,34.232,21.026,47.558;P＜0.001);治疗前,治疗后4周、8周、12周PANSS总分及阳性、阴性、一般精神病理症状分组间差异无统计学意义.奥氮平组和氯氮平组在治疗中均无严重不良反应发生,两组不良反应差异无统计学意义.结论 高剂量奥氮平具有很好的安全性,可代替氯氮平治疗难治性精神分裂症.