喹硫平与氯氮平治疗女性精神分裂症对照研究

目的：探讨喹硫平与氯氮平治疗女性精神分裂症的临床疗效和安全性。方法将86例女性精神分裂症患者随机分为两组,分别口服喹硫平与氯氮平治疗,观察8周。采用阳性与阴性症状量表评定临床疗效、副反应量表评定不良反应。结果治疗8周末喹硫平组总有效率为88．4％,氯氮平组为86．0％,两组比较差异无显著性（χ^2＝0．10,P＞0．05）;喹硫平组不良反应较轻微,其中嗜睡、月经紊乱、泌乳、体质量增加、心电图及脑电图异常等不良反应发生率显著低于氯氮平组（P＜0．05）。结论喹硫平与氯氮平治疗女性精神分裂症疗效显著且相当,但喹硫平对女性内分泌的影响甚微,不增加体质量,更适用于女性精神分裂症患者。     

喹硫平与利培酮治疗精神分裂症对照研究

目的探讨喹硫平与利培酮治疗精神分裂症的临床疗效及安全性。方法将56例精神分裂症患者随机分为两组,每组28例,研究组口服喹硫平治疗,对照组口服利培酮治疗,观察8周。采用阳性与阴性症状量表及副反应量表评定临床疗效和不良反应,并于治疗前后测定血清催乳素水平。结果治疗8周末研究组显效率67．8％、有效率92．8％,对照组分别为64．2％、89．2％,两组比较差异无显著性（x2=0．08、0．22,P〉0．05）;研究组治疗前催乳素水平与对照组比较差异无显著性,治疗后显著低于对照组（P〈0．01）;两组不良反应均轻微,但研究组静坐不能、体质量增加及月经紊乱／泌乳发生率均显著低于对照组（P〈0．05）。结论喹硫平与利培酮治疗精神分裂症疗效均显著,但喹硫平治疗不引起体质量增加及催乳素水平升高,较少发生锥体外系反应,安全性更高,依从性更好。     

阿立哌唑与利培酮治疗首发精神分裂症对照研究

目的探讨阿立哌唑与利培酮治疗首发精神分裂症的临床疗效与安全性。方法将60例首发精神分裂症患者随机分为两组各30例,研究组口服阿立哌唑治疗,对照组口服利培酮治疗,观察6w。于治疗前及治疗2w、4w、6w末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应。结果治疗6w末研究组显效率70．0％,对照组73．3％,两组显效率无显著性差异（P〉0．05）。治疗2w末起两组阳性与阴性症状量表总分及各因子分均较治疗前显著下降（P〈0．05或0．01）,同期两组间比较均无显著性差异（P〉0．05）。两组不良反应均轻微,研究组静坐不能、体重增加、月经改变及泌乳发生率显著低于对照组,但差异无显著性（P〉0．05）。结论阿立哌唑治疗精神分裂症的疗效与利培酮相当,但对内分泌系统影响较利培酮小。     

奎硫平与利培酮治疗首发精神分裂症对照研究

目的探讨奎硫平与利培酮治疗首发精神分裂症的远期疗效、安全性以及对患者生活质量的影响。方法将102例首发精神分裂症患者随机分为奎硫平组和利培酮组,分别口服奎硫平与利培酮治疗,并进行全病程管理,观察1a。于治疗前及治疗2周、6周、3个月、6个月、12个月末采用简明精神病量表评定临床疗效,生活质量综合评定问卷-74评估患者的生活质量,副反应量表评定不良反应。结果治疗2周末起两组简明精神病量表评分均较治疗前有显著性下降（P〈0．01）,同期两组间比较均无显著性差异（P〉0．05）;治疗12月末,奎硫平组总有效率为92．68％,利培酮组为89．47％,两组无显著性差异（P〉0．05）。治疗后两组生活质量综合评定问卷-74评分均较治疗前呈持续性升高;两组治疗6周末起心理健康维度、治疗6个月末起躯体健康、社会功能维度分均较治疗前显著升高,差异有显著或极显著性（P〈0．05或0．01）;同期两组问比较均无显著性差异（P〉0．05）。利培酮主要不良反应为锥体外系反应和体重增加;奎硫平主要为头晕、嗜睡、便秘。治疗后两组副反应量表评分均呈持续性下降,治疗6个月末起均显著低于治疗2周末（P〈0．05或0．01）;同期两组间比较奎硫平组治疗2周末、6周末显著低于对照组（P〈0．05）,其他时段评分均无显著性差异（P〉0．05）。结论奎硫平与利培酮治疗首发精神分裂症远期疗效显著、不良反应轻微、安全性高、依从性好,能显著提高患者的生活质量,促进患者的全面康复。     

利培酮喹硫平齐拉西酮对首发精神分裂症患者代谢指标的影响

目的：探讨利培酮、喹硫平、齐拉西酮对首发精神分裂症患者代谢指标的影响。方法将120例首发精神分裂症患者按随机数字表法分为3组,分别口服利培酮、喹硫平、齐拉西酮治疗,观察12周。于治疗前后采用阳性与阴性症状量表评定临床疗效,同时检测血压、腰围及空腹血糖、三酰甘油、高密度脂蛋白胆固醇水平的变化,统计各时点代谢综合征发生率。结果治疗后利培酮组总有效率为89．2％、喹硫平组为88．9％、齐拉西酮组为86．5％,3组间比较差异无显著性（P＞0．05）。治疗4周末起利培酮组、喹硫平组腰围、三酰甘油、空腹血糖水平较治疗前显著升高,治疗12周末3组腰围、三酰甘油、空腹血糖水平均较治疗前显著升高（ P＜0．05或0．01）,利培酮组、喹硫平组高密度脂蛋白胆固醇水平较治疗前显著下降（P＜0．05）;治疗各时点利培酮组与喹硫平组腰围、三酰甘油水平及代谢综合征发生率均显著高于齐拉西酮组（ P＜0．05或0．01）。结论利培酮、喹硫平、齐拉西酮治疗首发精神分裂症疗效均显著,总体疗效相当,但对患者机体代谢均存在不同程度的影响,其中利培酮、喹硫平最为明显,齐拉西酮影响较小。     

齐拉西酮与利培酮治疗女性精神分裂症的对照研究

目的比较齐拉西酮与利培酮对女性精神分裂症的疗效及副作用。方法将符合CCMD-3精神分裂症诊断标准的60例女性患者随机分为两组，分别给予齐拉西酮与利培酮治疗，疗程为8周。以阳性症状和阴性症状量表（PANSS）、精神药物副反应量表（TESS）评定疗效及副反应。结果治疗8周后，两组患者的PANSS评分均明显减少，差异有显著性（P〈0．01）。两组间比较PANSS评分差异无显著性（P〉0.05）．齐拉西酮组副反应发生率低于利培酮组，差异无显著性（P〉0．05），但齐拉西酮组的月经紊乱、锥体外系副反应（EPS）、体重增加等不良副反应均比对照组少，具有显著性差异。结论齐拉西酮与利培酮对女性精神分裂症的疗效相当，有效率分别为93．3％、90．0％。齐拉西酮锥体外系副反应和内分泌改变较利培酮少，更适用于女性精神分裂症患者。     

喹硫平利培酮联合氯氮平治疗对难治性精神分裂症患者疗效及血清催乳素水平的影响

目的探讨喹硫平联合氯氮平与利培酮联合氯氮平治疗难治性精神分裂症的临床疗效和安全性以及对催乳素水平的影响。方法将64例难治性精神分裂症患者随机分为两组,每组32例,研究组口服喹硫平联合氯氮平治疗,对照组口服利培酮联合氯氮平治疗,观察12周。于治疗前及治疗第2周、4周、8周、12周末采用阳性与阴性症状量表、临床总体印象量表评定临床疗效,副反应量表评定不良反应,治疗前及治疗12周末测定血清催乳素水平。结果治疗后两组阳性与阴性症状量表总分及各因子分、临床总体印象量表评分均较治疗前显著下降（P〈0．01）,同期研究组较对照组下降更显著（P〈O．05）。治疗12周末,研究组显效率显著高于对照组（x^2=4．00,P〈0．05）,总有效率与对照组比较差异无显著性（x^2=0．78,P〉0．05）;研究组治疗各时段副反应量表评分、不良反应发生率及血清催乳素水平均显著低于对照组（P〈O．05或0．01）。结论喹硫平联合氯氮平治疗难治性精神分裂症的临床疗效优于利培酮联合氯氮平治疗,安全性更高,对血清催乳素水平的影响相对较小。     

喹硫平利培酮阿立哌唑对精神分裂症患者认知功能的影响

目的：探讨喹硫平、利培酮和阿立哌唑对精神分裂症患者临床疗效及认知功能的影响。方法将154例精神分裂症患者分为3组,分别口服喹硫平（65例）、利培酮（47例）和阿立哌唑（42例）治疗,观察24周。采用阳性与阴性症状量表评定临床疗效,重复性成套神经心理状态测验评定认知功能。结果治疗24周末3组阳性与阴性症状量表评分均有显著改善,但喹硫平组改善阳性症状显著优于利培酮组和阿立哌唑组（P＜0．05）;3组重复性成套神经心理状态测验的9个因子分比较差异有显著性（ P＜0．05或0．01）,阿立哌唑组对8个因子分的改善优于其他2组。不同性别、文化程度患者的认知功能改善有显著性差异（P＜0．05）。合并躯体疾病患者认知功能的改善显著差于单纯精神分裂症患者（P＜0．05）。结论喹硫平、利培酮和阿立哌唑均能显著改善精神分裂症患者的各种精神症状及认知功能;合并躯体疾病的患者认知功能改善差于单纯精神分裂症患者,性别、文化程度是影响认知功能改变的重要因素。     

阿立哌唑与利培酮治疗首发精神分裂症对照研究

目的疗首发精神分裂症患者的临床疗效及安全性。方法将64例精神分裂症患者随机分为两组各32例,研究组口服阿立哌唑治疗,对照组口服利培酮治疗,观察8周。于治疗前及治疗2周、4周、6周、8周末采用阳性与阴性症状评定量表及副反应量表评定临床疗效和不良反应。结果治疗后两组阳性与阴性症状评定量表阳性症状、阴性症状因子分均较治疗前有显著下降（P均〈0．05或0．01）,同期两组间评分均无显著性差异（P均〉0．05）;治疗8周末,研究组显效率65．6％,有效率84．4％,对照组分别为68．8％和87．5％,两组比较无显著性差异（P〉0．05）。两组不良反应均轻微,主要表现为嗜睡、头痛头昏、体位性低血压等;但研究组锥体外系反应、月经失调、泌乳及体重增加的发生率均显著低于对照组（P均〈0．05）。结论阿立哌唑治疗首发精神分裂症患者疗效显著且与利培酮相当,安全性高,更适合女性精神病患者。     

奎硫平与氯氮平治疗精神分裂症的比较研究

目的比较奎硫平和氯氮平治疗精神分裂症的临床疗效与安全性。方法对60例首次住院的精神分裂症患者，随机分为奎硫平和氯氮平两组，分别进行8周治疗，采用阳性症状与阴性症状量表（PANSS）及副反应量表（TESS）评定疗效及不良反应。结果两组疗效差异统计学意义（P〉0．05），奎硫平的不良反应少于氯氮平。结论奎硫平治疗精神分裂症疗效好，不良反应轻。     

思瑞康和维思通治疗精神分裂症的临床研究

目的　以维思通为对照组 ,探讨思瑞康治疗精神分裂症的疗效和副作用。方法　将 65例符合CCMD 3的精神分裂症患者随机分为两组 ,分别给予思瑞康和维思通治疗 8周。采用阳性症状和阴性症状量表 (PANSS)评定临床疗效 ,副反应量表 (TESS)评定副反应。结果　治疗 8周后的疗效相当 (P >0 .0 5 ) ;思瑞康组和维思通组的显效率差异无显著性 (P >0 . 0 5 ) ;思瑞康组的副反应发生率低于维思通组 ,但差异无显著性 (P >0 . 0 5 ) ;维思通组锥体外系副反应和内分泌改变的发生率均明显高于思瑞康组 (P <0. 0 5 ) ,但两药引起的副反应一般为轻度或中度 ,患者耐受性较好。结论　思瑞康和维思通对精神分裂症的疗效相当 ,但副作用有所不同。     

奎硫平与利培酮治疗精神分裂症对照研究

目的 评价国产奎硫平对精神分裂症患者的疗效和副作用。方法 将60例首次住院的精神分裂症女性患者随机分为两组,每组30例,分别用奎硫平和利培酮治疗6w,采用PANSS评定疗效,TESS评定副反应。结果奎硫平组显著进步20例,进步6例,无效4例;利培酮组分别为18例,9例和3例,两组比较差异无显著性(P>0.05)。两组疗前与疗后各周PAN-SS总分比较均有显著性差异(P<0.01),但两组间比较差异无显著性(P均>0.05)。两药均在第2w开始起效,两组疗效无显著性差异。两组不良反应均为轻至中度,发生率及严重程度无显著性差异。结论 奎硫平对精神分裂症有肯定疗效,且安全性高。     

帕利哌酮与利培酮治疗精神分裂症疗效及安全性的M eta分析

目的：探讨帕利哌酮与利培酮治疗精神分裂症疗效和不良反应的差异性。方法对帕利哌酮与利培酮治疗精神分裂症疗效和不良反应的6篇文献进行M eta分析。结果帕利哌酮与利培酮治疗精神分裂症的显效率、总有效率比较差异无显著性（P＞0．05）;帕利哌酮组的锥体外系不良反应、高泌乳素血症发生率显著低于利培酮组（P＜0．05）。结论帕利哌酮治疗精神分裂症总体疗效与利培酮相当,但帕利哌酮安全性更高,依从性更好。     

Selection of atypical antipsychotics for the management of schizophrenia

OBJECTIVE: To review the evidence for selecting one atypical antipsychotic agent over another for management of schizophrenia. DATA SOURCES: A literature search of MEDLINE (1966-June 2003), EMBASE (1998-June 2003), and the Cochrane Library was conducted using the following terms: schizophrenia, quetiapine, ziprasidone, olanzapine, aripiprazole, and risperidone. Bibliographies of relevant articles were hand-searched for additional references. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, blinded trials and meta-analyses that directly or indirectly compared > or =2 atypical antipsychotic agents in the management of schizophrenia are included in this review. Studies comparing an atypical agent with clozapine are not included. DATA SYNTHESIS: A small number of prospective, randomized, blinded trials that compare efficacy and tolerability of olanzapine and risperidone have been published. These trials did not reveal clinically meaningful differences in efficacy but did confirm that their adverse effect profiles are slightly different (more weight gain with olanzapine and more extrapyramidal reactions with risperidone). Direct comparisons between other atypical antipsychotics are not available. Systematic reviews (indirect comparisons) of placebo-controlled or traditional antipsychotic-controlled trials suggest similar efficacy for quetiapine, olanzapine, and risperidone when placebo is the comparator and inferior efficacy of quetiapine compared to olanzapine and risperidone when haloperidol is the comparator. The few available economic analyses are difficult to interpret in light of current practice. CONCLUSIONS: Additional randomized, blinded clinical trials directly comparing efficacy, tolerability, and cost-effectiveness are needed to confirm the proposed differences among atypical antipsychotic agents before recommendations can be made with confidence.     

Atypical antipsychotics and dopamine D(1) receptor agonism: an in vivo experimental study using core temperature measurements in the rat

The study objectives were to examine the effects of the atypical antipsychotic drugs olanzapine, risperidone, and quetiapine on core temperature in the rat in relation to such effects produced by clozapine and to compare possible in vivo intrinsic efficacy of olanzapine, risperidone, and quetiapine at dopamine (DA) D(1) receptors with such effects previously shown for clozapine. Core temperature measurements were made in adult male Wistar rats maintained under standard laboratory conditions using a reversed 12-h daylight cycle. Clozapine (0-32 micromol/kg s.c.), olanzapine (0-32 micromol/kg s.c.), and risperidone (0-4 micromol/kg s.c.) all produced a dose-dependent hypothermia. Except for slight nondose-dependent hyperthermia, there were no effects of quetiapine (0-16 micromol/kg s.c. or i.p.) on the core temperature. The hypothermia produced by clozapine, but not that produced by equipotent doses of olanzapine or risperidone, was fully antagonized by pretreatment with the DA D(1) receptor antagonist SCH-23,390 (0.1 micromol/kg s.c.). On the other hand, quinpirole-induced hypothermia (4 micromol/kg s.c.) was partially antagonized by olanzapine (2 micromol/kg s.c.), risperidone (4 micromol/kg s.c.), and quetiapine (16 micromol/kg s.c.) but not by clozapine (1 micromol/kg s.c.). Clozapine preferentially stimulates DA D(1) receptors in comparison with olanzapine and risperidone, whereas olanzapine, risperidone, and quetiapine preferentially block DA D(2) receptors compared with clozapine. It is suggested that stimulation of DA D(1) receptors, presumably in the prefrontal cortex, is a distinguishing feature of clozapine responsible for its favorable profile on cognitive functioning in schizophrenia.     

阿立哌唑与奎硫平治疗精神分裂症疗效研究

目的比较阿立哌唑与奎硫平治疗精神分裂症患者的疗效与不良反应。方法将142例首发精神分裂症患者，随机分为阿立哌唑组及奎硫平组进行治疗，分别在治疗前及治疗2、4、8周末采用阳性与阴性症状量表（PANSS）评定临床疗效，用治疗中出现的症状量表（TESS）评定药物不良反应。结果阿立哌唑的疗效与奎硫平相当，阿立哌唑的显效率81．69％奎硫平的显效率78．87％，组间比较差异无显著性（P〉0．05）。阿立哌唑组的不良反应明显少于奎硫平组，组间比较有显著性差异（P〈0．05）。结论阿立哌唑是一安全有效、不良反应少的抗精神分裂症药。     

奎的平与氯丙嗪治疗精神分裂症对照观察

目的 比较奎的平与氯丙嗪治疗精神分裂症的临床疗效和副作用。方法 对我院符合入组标准的89例精神分裂症患者随机分为奎的平组(44例)和氯丙嗪组(45例),用PANSS、CGI、TESS评定其疗效和副作用。结果 治疗后两组PANSS评分、CGI评分无显著差异(P>0.05),TESS评分奎的平组副反应少于氯丙嗪组,治疗期间氯丙嗪组合用安坦27例(62.8％),奎的平组12例(29.3％),差异有非常显著性(P<0.01)。结论奎的平治疗精神分裂症同氯丙嗪疗效相当,不良反应较氯丙嗪轻微。     

奎硫平与利培酮治疗老年精神分裂症对照研究

目的探讨奎硫平与利培酮治疗老年精神分裂症的临床疗效及安全性。方法将60例老年精神分裂症患者随机分为两组各30例,研究组口服奎硫平治疗,对照组口服利培酮治疗,观察8w。于治疗前及治疗1w、2w、4w、8w末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应。结果治疗8w末,研究组显效率为83．3％、总有效率为93．3％;对照组分别为86．7％、93．3％,两组总体疗效相当（P〉0．05）。两组治疗第1w末起阳性与阴性症状量表总分及各因子分较治疗前均明显下降,不良反应程度均较轻微,但研究组总不良反应发生率显著少于对照组（P〈0．05）,尤其是锥体外系反应及体重增加等明显少于对照组（P〈0．05）,而直立性低血压和心电图改变发生率明显高于对照组（P〈0．05）。结论奎硫平与利培酮治疗老年精神分裂症的疗效显著且相当,不良反应均轻微,但表现形式有所不同。     

A comparison of the relative safety, efficacy, and tolerability of quetiapine and risperidone in outpatients with schizophrenia and other psychotic disorders: the quetiapine experience with safety and tolerability (QUEST) study.

BACKGROUND: The few published direct comparative studies of the tolerability and efficacy of atypical antipsychotic agents were performed in relatively homogeneous populations that may not be typical of patients seen in clinical practice. OBJECTIVE: The Quetiapine Experience with Safety and Tolerability (QUEST) study compared the relative safety, tolerability, and efficacy of quetiapine and risperidone in outpatients with a broad range of psychotic symptoms. METHODS: This was a multicenter, 4-month, open-label, randomized clinical trial. Patients were randomized in a 3:1 ratio to receive quetiapine or risperidone. Doses were adjusted to maximize efficacy and to minimize adverse events. Extrapyramidal symptoms (EPS) were assessed with an EPS checklist; adverse events were recorded. Efficacy was assessed using the Clinical Global Impression (CGI) scale, Positive and Negative Symptom Scale (PANSS), and Hamilton Rating Scale for Depression (HAM-D). RESULTS: A total of 728 patients were randomized, 553 to quetiapine and 175 to risperidone. Mean prescribed doses over the study period were 253.9 mg/d quetiapine and 4.4 mg/d risperidone. At the end of 4 months, EPS declined in both treatment groups, but quetiapine-treated patients were significantly less likely to require dose adjustment or concurrent anti-EPS medication (P < 0.001). The most common adverse events in the quetiapine and risperidone groups were somnolence (31.3% and 15.4%, respectively), dry mouth (14.5% and 6.9%), and dizziness (12.7% and 6.9%). Overall, tolerance to side effects with the 2 drugs, measured by dropout rates, was comparable. At each visit, a higher percentage of quetiapine-treated patients showed improvement on the CGI scale, but there were no significant between-group differences on the PANSS. At end point, quetiapine-treated patients had significantly lower HAM-D scores (P = 0.028). CONCLUSIONS: The results of this study suggest that quetiapine is as effective as risperidone for the treatment of psychotic symptoms, is more effective for depressive symptoms, may have a more favorable EPS profile, and has comparable overall tolerability.