阿立哌唑与氯氮平治疗精神分裂症对照研究

目的:探讨阿立哌唑与氯氮平对首发精神分裂症患者的临床疗效及安全性。方法:对64例精神分裂症患者随机分为两组,分别给予阿立哌唑与氯氮平治疗,疗程8周。用阳性与阴性症状量表(PANSS)和副反应量表(TESS)评定疗效和不良反应。结果:两组疗效差异无显著性(P>0.05),阿立哌唑不良反应显著少于氯氮平(P<0.01)。结论:阿立哌唑是一种安全有效的抗精神病药。     

阿立哌唑治疗精神分裂症的多中心随机双盲对照试验

目的:评价阿立哌唑治疗精神分裂症的疗效及安全性。方法:采用多中心随机双盲双模拟、阳性药平行对照的方法。以利司哌酮(昔名利培酮)为对照,受试者分别口服阿立哌唑10~30 mg.d-1与利司哌酮2~6 mg.d-1,疗程42 d。结果:共收集精神分裂症病人222例,其中阿立哌唑组111例与利司哌酮组111例。治疗结束时,2组PANSS总分与BPRS总分较治疗前均显著降低(P<0.01);PANSS总分减分率阿立哌唑组(65±s28)%,利司哌酮组为(67±26)%,差异无显著意义(P>0.05)。临床总有效率:阿立哌唑组为77.0%,利司哌酮组为79.2%,2组比较差异无显著意义(P>0.05)。阿立哌唑组常见的不良反应为:静坐不能、震颤、失眠、心动过速,不良反应较利司哌酮组少。结论:阿立哌唑治疗精神分裂症的疗效与利司哌酮相似,不良反应较利司哌酮为少,是一种安全而有效的抗精神病药。     

顶空气相色谱法测定阿立哌唑中有机溶剂N,N-二甲基甲酰胺残留量

目的:建立测定阿立哌唑原料药中的有机溶剂N,N-二甲基甲酰胺(DMF)残留量的方法.方法:采用顶空气相色谱法,DB-624毛细管柱(30m×0.53mm,3μm),载气为氮气,流速20mL·min-1,柱温90℃;气化室温度160℃;氢火焰离子化检测器(FID)温度170℃.结果:在浓度范围9.32～1.19×103μg·mL-1内,线性关系良好,r=0.999 9,平均回收率为98.4%.最小检测浓度为4.7μg·mL-1.结论:本方法灵敏,精确,可靠,适用于测定阿立哌唑原料药中的有机溶剂DMF残留量.     

Proposed strategies for successful clinical management with aripiprazole

Background: Aripiprazole is an effective medication for treating patients with schizophrenia and bipolar disorder , and as an adjunct in patients with major depressive disorder and an inadequate response to antidepressant treatment, that is generally safe and well tolerated. Despite its potential clinical benefits, the management of aripiprazole-treated patients can be challenging due to the lack of a simple dosing strategy and guidelines for preventing and managing potential adverse effects. Objective: Two initiation/dosing strategies with aripiprazole are presented that are based on the overall symptom profile rather than specific clinical diagnosis: a rapid titration/high-dose strategy and a slow titration/low-dose strategy. Methods: The dosing strategy recommendations are based on clinical experience and a PubMed database search conducted with no date restrictions for English-language literature. Keywords included aripiprazole, dose switching or strategy, schizophrenia or bipolar disorder and adverse effects. Conclusions: Two strategies have been designed to help clinicians tailor aripiprazole therapy to the specific needs of individual patients and manage common adverse effects that may be encountered during therapy.     

Long-Term Aripiprazole in Youth With Developmental Disabilities Including Autism

We retrospectively reviewed clinic charts of 21 children and adolescents with developmental disabilities including autism spectrum disorders (ASD) treated consecutively with aripiprazole (ARI) for irritability and severe challenging behaviors. Data extracted include age, sex, and race; level of intellectual disability (ID); Diagnostic and Statistical Manual-IV diagnoses including comorbidity, ARI dosage, and treatment duration; other psychoactive medications and Clinical Global Impressions–Improvement (CGI-I) at baseline and end point; weight; height; and side effects. Body mass index (BMI) z scores are compared with Centers for Disease Control norms. Eleven boys and 10 girls with ID and/or ASD ages 8 to 18 years (mean age 13.4 years) received ARI; mean dose was 8.4 mg/day (range 2.5 to 15); average duration was 60.6 weeks (7 to 132). Eleven of 21 patients (52%) met CGI-I response of ≤ 2. ARI was well tolerated, including together with stimulants, divalproex, or less commonly other medications. Mean BMI was 23.8 ± 5.9 at baseline and 24.2 ± 5.2 at end. Mean BMI z score increase was 0.06 ± 0.67. Four individuals (19%) manifested early intolerable weight gain. In this long-term clinical sample, ARI was effective in 52% and well tolerated. ARI was mostly weight neutral; early weight gain was intolerable in 19%. Larger long-term outcome studies are warranted in this population.     

某炼油厂466名苯作业工人职业健康状况分析

目的　探讨头孢曲松钠联合阿立哌唑对神经梅毒患者的临床治疗效果。方法　选取2014年1月—2019年2月淄博市第一医院收治的78例神经梅毒患者作为研究对象，按照随机数字表法分为对照组（n=39）和观察组（n=39）。对照组采用青霉素联合阿立哌唑治疗，观察组采用头孢曲松钠联合阿立哌唑治疗，并完成4周治疗及12个月随访。比较2组阳性与阴性症状量表（positive and negative syndrome scale, PANSS）评分、临床疗效总评量表病情严重程度（clinical global impression- severity of illness, CGI-SI）评分、T细胞百分比、细胞因子水平、不良反应及复发情况。结果　观察组治疗后4周阴性症状评分、阳性症状评分、一般精神病理症状评分及PANSS总分下降幅度均大于对照组（P均＜0.05）；观察组治疗后4周CD3+ T细胞、CD4+ T细胞、CD4+/CD8+ T细胞 、IL-2、IL-12水平上升幅度均高于对照组（P均＜0.05）；观察组治疗后1、2、3、4周CGI-SI评分均低于对照组（P均＜0.05）；观察组治疗后6个月、12个月复发率均低于对照组（P均＜0.05）。结论　头孢曲松钠在治疗神经梅毒患者中，能改善患者神经症状，降低患者临床症状评分，提高患者T细胞百分比，改善细胞因子水平，降低治疗后复发率，药物安全性较高，值得推广应用。     

Aripiprazole for the treatment of irritability associated with autism

Introduction: Irritability (including tantrums, aggression and moodiness) is often associated with autistic disorder. Children with autism are frequently prescribed atypical antipsychotic medications for these behaviors. Although multiple agents have been found to be effective, the safety and tolerability of each antipsychotic may be the determining factor in its selection.

Areas covered: The pharmacokinetics, pharmacodynamics, safety and efficacy data on aripiprazole for the treatment of irritability associated with autism are discussed. Knowledge of the mechanism of action, advantages and disadvantages relative to other atypical antipsychotics, and an appreciation of the efficacy of aripiprazole when used to treat irritability in autism is also explored in this paper.

Expert opinion: Aripiprazole may have a more favorable side-effect profile than another commonly prescribed medication, risperidone, because of its unique mechanism of action. It seems to be effective in treating irritability associated with autism, but more research is needed.     

Switching antipsychotic medication to aripiprazole: position paper by a panel of Italian psychiatrists

Introduction: Patients with schizophrenia or bipolar disorder treated with antipsychotic medication can frequently experience lack of efficacy and persistent side-effects, so much so that switching from one antipsychotic to another with a different side-effect profile has become a recommended strategy for improving the tolerability and safety of long-term antipsychotic treatment. Aripiprazole is an atypical antipsychotic with proven efficacy in schizophrenia and bipolar I disorder, with a pharmacological profile distinct from other available antipsychotics and a side-effect profile that is different from other agents in the class; these characteristics make it a possible alternative in patients requiring a change in antipsychotic treatment due to lack of efficacy or persistent side-effects.

Areas covered: A panel of Italian experts in psychiatry met to discuss the appropriateness of current strategies for the switch to aripiprazole in patients with schizophrenia or bipolar disorder once a clinician has decided to adopt this choice and also to propose alternate strategies where required. The strategies for the switch to aripiprazole presented in this position paper consider various scenarios encountered in clinical practice, highlight the importance of tapering the prior antipsychotic based on its pharmacological characteristics and provide detailed guidance throughout the entire switching process. Literature searches were conducted using the PubMed database and the search strategy (aripiprazole and switching); additional references were added from the reference lists of the papers obtained and also from the authors’ knowledge of the topic.

Expert opinion: Few studies have addressed the indications for antipsychotic switching and the best practical strategies to achieve the desired goal in the clinical practice setting. Studies on antipsychotic switching should clarify why, when and how a switch should be done. The results should standardize the reasons for switching an antipsychotic, assess the optimal time to switch and evaluate the best ways to switch. Both clinical and pharmacological factors should be considered when a patient needs to switch antipsychotics, and specific guidelines for antipsychotic switching that address all these factors are needed.