利培酮、奥氮平和阿立哌唑对血清泌乳素水平的影响

目的探讨利培酮、奥氮平以及阿立哌唑对精神分裂症患者血清泌乳素（PRL）的影响。方法选择住院18～45岁女性精神分裂症患者随机分为利培酮组、奥氮平组及阿立哌唑组,每组40例。于治疗前,治疗4周、12周检测血清PRL并记录溢乳、月经情况。结果与治疗前比较,利培酮组及奥氮平组血清PRL升高,并有相应临床症状;阿立哌唑组无明显升高,几乎无影响。结论不同的非经典抗精神病药物对血清PRL的影响存在差异。     

奥氮平或喹硫平联合多奈哌齐治疗老年痴呆精神行为症状的疗效和安全性研究

目的探讨奥氮平或喹硫平联合多奈哌齐治疗老年痴呆精神行为症状的疗效和安全性。方法将103例伴精神行为症状的痴呆患者随机分为奥氮平联合多奈哌齐组（A组）与喹硫平联合多奈哌齐组（B组）。治疗前和研究结束时进行简易智力状态检查（MMSE）评分。在治疗后的第2、4、6、8周末以痴呆病理行为评定量表（BEHAVE-AD）减分率评定疗效,以副反应量表（TESS）记录治疗中各项药物不良反应。结果两组MMSE评分均较治疗前提高2分以上,治疗结束后两组组内比较,差异均有统计学意义（均P〈0.05）。治疗前后BEHAVE-AD量表评分两组组内比较,至第4周末时均明显下降,差异有高度统计学意义（均P〈0.01）。A组有效率为88.46%（46/52）,显著有效率为67.31%（35/52）;B组有效率为86.27%（44/51）,显著有效率为64.71%（33/51）,两组疗效比较差异无统计学意义（P〉0.05）。两组均无不能耐受的不良药物反应。结论奥氮平或喹硫平联合多奈哌齐治疗老年痴呆精神行为症状安全有效。     

西酞普兰并奥氮平对更年期抑郁症疗效观察

目的探讨西酞普兰合并奥氮平对更年期抑郁症的疗效。方法回顾性将2008年8月～2011年5月本院收治的更年期抑郁症患者64例,随机分为实验组和对照组,实验组用西酞普兰合并奥氮平治疗,对照组单用西酞普兰治疗,共治疗6周,采用汉密尔顿抑郁量表（HAMD）、改良的更年期症状评分表Kupperman（KMI）及副反应量表（Treat-ment Emergent Symptom Scale,TESS）评定疗效。结果治疗后,两组总治疗效果（显效＋有效）差异有统计学意义（X230．64,P〈0．05）;两组HAMD和KMI评分较治疗前均有显著性降低（P〈0．05）;6周后研究组的HAMD评分低于实验组,且差异具有统计学意义（P〈0．05）。两组不良反应均较少。结论西酞普兰合并奥氮平能更加有效地控制患者症状。值得推广。     

帕利哌酮缓释片治疗精神分裂症疗效观察

目的探讨帕利哌酮缓释片治疗精神分裂症的临床效果。方法将126例精神病患者按照随机数字表法分为治疗组和对照组,每组63例,治疗组给予帕利哌酮,起始剂量为6 mg/d,并根据病情2周内调整药量;对照组给予奥氮平,起始剂量为5～10 mg/d,并根据病情2周内调整剂量,均为口服治疗,1次/d,给药8周,观察和记录治疗效果,并对结果进行分析。结果治疗组痊愈4例,显效37例,好转14例,无效8例,总有效率为87.3%;对照组组痊愈2例,显效36例,好转15例,无效10例,总有效率为84.1%;两组总疗效比较差异有统计学意义(P>0.05)。结论帕利哌酮缓释片用于治疗精神分裂症患者耐受性好,不良反应轻,可有效的改善患者阳性症状和阴性症状,值得临床推广应用。     

奥氮平合并阿立哌唑治疗老年痴呆躁狂发作的疗效观察

目的总结奥氮平与阿立哌唑联合应用治疗老年痴呆躁狂发作的疗效及耐受性与安全性。方法收集笔者所在医院2009年1月～2011年6月收治的老年痴呆躁狂发作患者42例,随机分为阿立哌唑组、奥氮平组及阿立哌唑与奥氮平联合组,各14例,治疗8周后观察评定3组患者的治疗效果及不良反应。结果联合用药组在总有效率及不良反应方面均明显优于其他两组,其他组间比较差异无统计学意义。结论奥氮平与阿立哌唑联合应用治疗老年痴呆躁狂发作疗效明显,不良反应少,值得在临床推广应用。     

Antipsychotic treatment discontinuation in previously untreated patients with schizophrenia: 36-month results from the SOHO study

Data from the 3-year, prospective, observational SOHO study were used to compare the effectiveness (in terms of treatment discontinuation) and the tolerability of olanzapine, risperidone, other atypicals and typical antipsychotics in 1009 previously untreated outpatients with schizophrenia who started monotherapy at baseline. Kaplan-Meier survival analysis estimated the time to treatment discontinuation by the treatment group, Cox proportional hazards regression models identified the variables associated with treatment discontinuation (adjusted for baseline differences between treatment groups), and logistic regression models compared the tolerability profiles of the different treatment groups. Of the 931 patients analyzed, 31.9% discontinued the medication initiated at baseline during the 3-year follow-up. Olanzapine had the lowest rate of discontinuation (28.9%), followed by other atypical (34.0%), risperidone (36.2%) and typical antipsychotics (44.5%). Compared to olanzapine, risk of treatment discontinuation was higher with typical antipsychotics (hazard ratio [HR] 1.75; 95% confidence interval [CI] 1.11, 2.78) or risperidone (HR 1.36; 95% CI 1.02, 1.82). A higher baseline Clinical Global Impression (CGI) positive score was associated with a higher risk of treatment discontinuation (HR 1.18; 95% CI 1.06, 1.30). Olanzapine was associated with a lower frequency of extrapyramidal symptoms than other antipsychotics, fewer prolactin-related adverse events than risperidone and other atypical antipsychotics, but greater weight gain than typicals and risperidone. For all analyses, comparison with the other atypical group is limited due to its small sample size (n = 50). In conclusion, treatment effectiveness and tolerability varied among antipsychotic medications in previously untreated patients with schizophrenia. The results should be interpreted conservatively given the observational study design.     

Olanzapine-induced weight gain in anorexia nervosa: Involvement of leptin and ghrelin secretion?

BACKGROUND: Olanzapine (OLA) administration has been reported to induce weight gain in experimental animals and humans, through not yet fully defined mechanisms of action. Aim of this study was to determine whether in patients with Anorexia Nervosa (AN) OLA induces weight gain through the modulation of the hunger-satiety regulatory peptides leptin and ghrelin. METHODS: Twenty anorexic probands received a 3 months course of cognitive-behavioral psychotherapy and programmed nutritional rehabilitation, combined with OLA PO (2.5 mg for 1 month and 5 mg for 2 months) in ten patients and with placebo PO (PL) in the other 10. Weight, measured as body mass index (BMI), leptin and ghrelin plasma values were monitored before starting the therapy and then monthly for 3 months. Plasma leptin was measured by ELISA, and plasma ghrelin by radioimmunoassay. RESULTS: BMI increased significantly but not differently in both treatment groups. Leptin and ghrelin secretion did not change during the course of the treatments. No correlations were observed between BMI values and leptin and ghrelin levels. CONCLUSIONS: Our data suggest that the weight gain observed in our OLA-treated patients was not linked to drug administration. Moreover, leptin and ghrelin secretions were not responsible for BMI changes.     

喹硫平与再普乐治疗酒精所致精神障碍的对照研究

目的：比较喹硫平与再普乐对酒精所致精神障碍患者的疗效和不良反应。方法：将68例酒精所致精神障碍患者随机分为喹硫平组（36例）和再普乐组（32例）,疗程6周;于治疗前及治疗后1、2、4、6周分别采用阳性症状和阴性症状量表（PANSS）、治疗时出现的症状量表（TESS）、锥体外系副反应量表（RSESE）评定疗效与不良反应。结果：喹硫平与再普乐对酒精所致精神障碍患者的治疗均有明显疗效,统计学上无显著性差异（P〉0．05）,锥体外系不良反应及其他副反应极少,两组统计学上无显著性差异（P〉0．05）。结论：喹硫平与再普乐治疗酒精所致精神障碍患者安全有效。     

Olanzapine plus 17-β estradiol produce antidepressant-like actions in rats forced to swim

Several combinations of effective treatments have been used in the search for higher response rates or more rapid responses than monotherapy to diminish treatment-resistant depression. One strategy is to combine olanzapine plus antidepressant drugs. In preclinical studies in male rats, olanzapine combined with fluoxetine produce antidepressant-like actions and increase the allopregnanolone levels in the brain. 17-β estradiol also produces antidepressant-like actions by increasing allopregnanolone levels. However, the effects of combining olanzapine with 17-β estradiol in the forced swimming test have not been tested before. Thus, systemic injections of vehicle plus olanzapine, or fluoxetine (20.0 mg/kg; 25.0 mg/kg) or 17-β estradiol (10.0 μg/rat; 20.0 μg/rat) reduced immobility by increasing active behaviors, which were cancelled by finasteride (finasteride was used to block the endogenous production of allopregnanolone by the brain) in ovariectomized rats forced to swim. Subthreshold doses of olanzapine (2.5 mg/kg) combined with subthreshold doses of 17-β estradiol (5.0 μg/rat) produced antidepressant-like actions, as did the combination subthreshold dose of olanzapine (2.5 mg/kg) plus the subthreshold dose of fluoxetine (15.0 mg/kg). Finasteride cancelled the antidepressant-like actions of the several combinations used. It is concluded that olanzapine alone or combined with fluoxetine or estradiol reduced immobility by increasing swimming. In conclusion, olanzapine produces antidepressant-like actions alone or in combination with estradiol. These antidepressant-like actions of this combination were cancelled by finasteride.