从抗精神病药的疗效谈起

从抗精神病药的疗效谈起于清汉抗精神病药物治疗精神病特别是精神分裂症始于５０年代初。１９５５年氯丙嗪引进我国并在临床广泛的应用。６０～７０年代又有奋乃静、三氟拉嗪、氟奋乃静、泰尔登、甲硫哒嗪等问世，继而氟哌啶醇、舒必利、氯氮平和新近的产品利培酮先后相继...     

典型与非典型抗精神病药对首发精神分裂症P50感觉门控的作用

目的 比较典型与非典型抗精神病药对P50感觉门控的作用.方法 运用条件-测试刺激模式和刺激序列模式两种方法检测61例首发精神分裂症患者(治疗前后)和36名正常对照的P50听觉诱发电位.患者组依治疗情况分为典型抗精神病药(奋乃静,舒必利)治疗组(简称典型组)和非典型抗精神病药(氯氮平、奥氮平、利培酮和喹硫平)治疗组(简称非典型组),比较两组治疗前后P50感觉门控的差异.结果 治疗前,典型组和非典型组条件-测试刺激模式S2-P50波幅、P50抑制和刺激序列模式高频刺激P50波幅、P50抑制指标均差于对照组,差异均有统计学意义(P<0.05).治疗后,典型组条件-测试刺激模式S2-P50波幅、P50抑制指标虽有改善但与治疗前的差异无统计学意义(P>0.05),但刺激序列模式P50波幅、P50抑制明显改善,与治疗前的差异有统计学意义(P<0.05);非典型组两种模式下P50波幅、P50抑制指标均明显改善,与治疗前的差异均有统计学意义(P<0.05).结论 典型抗精神病药能够改善刺激序列模式P50感觉门控功能,但不能改善条件-测试刺激模式P50感觉门控功能;非典型抗精神病药物能同时改善条件-测试刺激模式和刺激序列模式P50感觉门控功能.     

非典型抗精神病药的抗抑郁效应

非典型抗精神病药具有治疗抑郁和焦虑的作用 ,用于抑郁症的治疗 ,也取得很好的效果 [1] ,而且还对伴发的妄想、幻觉有效[2 ] ,因此 ,已用于难治性抑郁症的治疗。非典型抗精神病药用于双相情感性精神障碍不仅有利于抑郁、躁狂症状的消失 ,而且还可以预防发作、中断转相。1　精神分裂症的抑郁症状1 .1　氯氮平 :氯氮平治疗的精神分裂症 ,近期和远期的自杀率都明显少于典型抗精神病药物 ,这主要与氯氮平减少抑郁、明显缓解精神病理学和改善认知功能有关 [3 ]。Melzter的研究发现 ,自杀的成功率降低 85% ,提示氯氮平有显著的抗抑郁效果 [4 ]。1…     

3种非典型抗精神病药对精神分裂症患者心电图的影响

目的:探讨3种非典型抗精神病药对精神分裂症患者心电图的影响。:方法:将270例精神分裂症患者随机分成3组,分别给予利培酮、阿立哌唑和齐拉西酮治疗,于治疗前和治疗2、4、8周进行心电图检查。结果:利培酮组、阿立哌唑组和齐拉西酮组的心电图异常率分别为27.8%、26.7%和22.2%。其中利培酮组与阿立派唑组女性异常率显著高于男性(P<0.05)。心电图改变主要为T波改变、窦性心动过速、窦性心动过缓、室性期前收缩、不完全右束支传导阻滞。结论:3种非典型抗精神病药对精神分裂症患者心电图均有影响,但轻而可逆。     

非典型抗精神病药治疗精神分裂症的评价(一)

精神分裂症是一组严重的精神疾病,虽然发病率不高,但因症状持续,起病于青壮年而导致较高的患病率和严重的功能损害而常危及家庭和社会。直到1952年临床实践中发现氯丙嗪具有抗精神病疗效和改善精神分裂症患者的精神症状,才开始了精神分裂症等精神病性障碍的现代治疗。之后的30多年间,氯丙嗪、氟哌啶醇等一直应用于临床,并称之为“经典抗精神病药（classic antlpsychotics）”,     

非典型抗精神病药对精神分裂症认知功能影响的研究进展

认知功能障碍已成为精神分裂症的核心症状之一,非典型抗精神病药对认知功能均有一定的改善作用。     

6种抗精神病药对精神分裂症首次发病患者认知功能影响的比较

目的：比较利培酮、奥氮平、奎硫平、阿立哌唑、齐拉西酮、氨磺必利6种抗精神病药对急性期首发精神分裂症患者认知功能的影响。方法：120例精神分裂症首发患者分为6个药物组,每组各20例,分别给予6种抗精神病药治疗,观察12周。采用阳性和阴性症状量表（ PANSS）、韦氏成人智力测验（ WAIS-RC）、威斯康星卡片分类测验（ WCST）、临床记忆量表（ CMS）在治疗前后评估疗效及认知功能。结果：与治疗前相比,各药物组PANSS阳性症状、阴性症状及总分在治疗后各时点均明显下降（P<0.05或P<0.01）;WAIS-RC、CMS、WCST评分均明显改善（P<0.05或P<0.001）;各组间比较,差异无统计学意义。相关分析显示,总智商差值与 PANSS总分及阴性症状差值呈正相关性（ r=0.559, r=0.755;P<0.01或P<0.001）,与阳性症状差值无相关（ r=0.148,P>0.05）。结论：6种新型抗精神病药均能改善首发精神分裂症患者的认知功能。     

精神分裂症患者非典型抗精神病药治疗前后的脑功能磁共振的研究进展

综述精神分裂症患者非典型抗精神病药治疗前后脑功能磁共振的研究进展。     

比较3种非典型抗精神病药对精神分裂症首次发作患者处理速度测验的影响

目的 比较奥氮平、利培酮和阿立哌唑三种非典型抗精神病药对精神分裂症首次发作患者处理速度测验成绩的影响.方法 91例精神分裂症首发患者随机分配至阿立哌唑组(n=27)、利培酮组(n=37)和奥氮平组(n=27),在治疗前和治疗12周末完成如下测验:阳性与阴性症状量表、沟槽钉板测验、连线测验、Stroop色词测验、数字符号编码测验和范畴流利测验.结果 (1)治疗12周后,三组PANSS评分均较治疗前显著降低(P ＜0.001),三组间PANSS减分率的差异无统计学显著性;(2)奥氮平组治疗后的利手、连线A、颜色连线1、颜色连线2以及Stroop测验B得分均较治疗前显著改善(P ＜0.05 ～0.001);利培酮组治疗后的连线A、颜色连线1、颜色连线2、Stroop测验C以及数字符号编码得分均较治疗前显著改善(P＜0.05～0.001);阿立哌唑组除颜色连线2外,其它各项评分的治疗前后比较差异无显著性(P＞0.05).结论 在对首发精神分裂症患者的处理速度的改善方面,奥氮平和利培酮可能优于阿立哌唑.     

妊娠期服用非典型抗精神病药文献复习

就妊娠期服用非典型抗精神病药对胎儿影响进行综述。     

首次发作精神分裂症患者出院服药情况1年调查

目的 了解首次发作(以下简称首发)精神分裂症患者出院服用抗精神病药的特点.方法 对137例首发精神分裂症患者出院后的服药情况进行问卷式跟踪随访调查1年,并比较服用第1代抗精神病药患者(64例)和第2代抗精神病药患者(73例)的差异.结果 首发精神分裂症患者服药依从性随时间推延逐渐降低,与所服药物类型无关.第1代抗精神病药组出院后第1、3、6、12个月的停药率分别为0%、7%、18%、50%,第2代抗精神病药组的停药率依次为3%、11%、21%、55%,2组各时点的差别无统计学意义.第1代抗精神病药锥体外系不良反应明显多于第2代抗精神病药,随访第12个月时分别为30%、7%, χ2=12.310,P<0.01.而后者在随访第12个月时出现内分泌系统不良反应比例(40%)高于第1代抗精神病药(5%)(χ2=13.433,P<0.05).结论 如何提高首发精神分裂症长期维持治疗的依从性是精神卫生服务的重要内容.     

非经典抗精神病药对代谢的影响

目的：探讨非经典抗精神病药对精神分裂症患者血糖、糖化血红蛋白（HbA1C）、三酰甘油（TG）、高密度脂蛋白（HDL）和体质量的影响。方法：将176例精神分裂症患者分成氯氮平组（30例）、奥氮平组（30例）、奎硫平组（30例）、利培酮组（30例）、阿立哌唑组（30例）和齐拉西酮组（26例）,治疗6周。于治疗前和治疗6周测量空腹血糖、HbA1C、TG、HDL和体质量。结果：治疗前后血糖、HbA1C、TG、HDL和体质量在阿立哌唑组和齐拉西酮组无显著变化,氯氮平组和奥氮平组治疗后显著增高（P〈0.05或P〈0.01）;奎硫平组和利培酮组可引起体质量显著增加（P〈0.01）,但对血糖、HbA1C、TG、HDL影响不大。结论：阿立哌唑、齐拉西酮对精神分裂症患者代谢的影响较小,奎硫平、利培酮次之,氯氮平、奥氮平对患者代谢的影响最大。     

Effect of switching to atypical antipsychotics on memory in patients with chronic schizophrenia

While the usefulness of atypical antipsychotics for improving cognitive function has been proven, the specific effects of these drugs are still unknown. The objective of this study was to investigate changes of the immediate memory and verbal working memory in patients with chronic schizophrenia after switching to one of four atypical antipsychotic agents and cessation of anticholinergic therapy. The subjects included 77 schizophrenic patients who were treated primarily with typical antipsychotics. Treatment was randomly switched to one of four atypical antipsychotics (olanzapine, perospirone, quetiapine, or risperidone) over a 4-week period, and then the drug was continued for another 4 weeks while the patient was taken off anticholinergics. The immediate memory, verbal working memory, and symptoms were evaluated. Significant improvement of immediate memory was only seen with olanzapine and risperidone. Improvement was also seen after switching to perospirone, but immediate memory worsened after treatment with this anticholinergic drug was discontinued. Deterioration was seen after switching to quetiapine, but immediate memory improved and reached the previous level after treatment with anticholinergic drugs was discontinued. Significant improvement of the verbal working memory was only seen during risperidone administration. The findings suggested that switching chronic schizophrenic patients to atypical antipsychotics can improve both the immediate memory and the verbal working memory when risperidone is used, while improvement of immediate memory can be expected with olanzapine. From the viewpoint of improving the memory, quetiapine should not be administered concomitantly with anticholinergic drugs, and caution should be exercised when discontinuing anticholinergic drugs during treatment with perospirone.     

A topographic event-related potential follow-up study on `prepulse inhibition' in first and second episode patients with schizophrenia

Dopamine agonists impair and antagonists normalize prepulse inhibition (PPI) of startle and gating of the P50 event-related potential (ERP), but the within-subject effect of treatment on impaired gating in schizophrenia has not been studied. We report the first results of a longitudinal study using PPI of ERPs as a measure of sensory gating in an auditory Go/NoGo discrimination. After admission and approximately 3 months later, at discharge, 15 patients with schizophrenia performed a discrimination between a 1.4 kHz target tone and an 0.8 kHz non-target tone with no prepulse, or with a prepulse at 100 ms or 500 ms before either tone. ERPs were recorded from 19 sites. Healthy subjects were studied twice, with 3 months between sessions. PPI of the P50 peak in the 100-ms condition was reduced in patients on admission. At discharge, decreased negative symptoms correlated with enhanced P50-PPI at frontocentral sites. After treatment increased N100-PPI at centrotemporal sites correlated with fewer positive symptoms. At frontal sites in the 100-ms condition, the initially small difference of non-target minus target P300 amplitudes increased as negative symptoms decreased. It is concluded that weak auditory prepulses interfere with early auditory stimulus processing (P50), channel selection (N100) and selective attention (P300). Gating of these stages of processing is impaired in psychotic patients and treatment tends to normalize gating in tandem with improvements of different types of symptoms.     

Differences of satisfaction with medication between patients with schizophrenia treated with typical antipsychotics and atypical antipsychotics

Many studies have demonstrated that atypical antipsychotics are superior to typical antipsychotics in that they have fewer side-effects and produce better improvement of cognitive deficits and quality of life in patients with schizophrenia. However, most of these studies dealt with objective indices assessed by researchers rather than subjective indices that are indeed important to patients themselves. In 126 patients with schizophrenia, annoyance of side-effects and psychotic symptoms, satisfaction with medication, wish to change medication, and knowledge of atypical antipsychotics were assessed using questionnaires. Patients treated with typical antipsychotics complained less of annoyance of poor attention and concentration than those treated with atypical antipsychotics, which can be explained by increased awareness of these symptoms by the patients due to the improvement of cognitive function. There were no significant differences between the two groups in other variables. The present results that satisfaction and annoyance were similar between patients treated with typical antipsychotics and those with atypical antipsychotics, may partly explain why patients hesitated and rejected changing or shifting from typical to atypical antipsychotics. But because 98 of 126 patients did not know about atypical antipsychotics, it is important to educate the patients on the merits of atypical antipsychotics.     

Health care utilization in patients with schizophrenia maintained on atypical versus conventional antipsychotics

1. Patients with schizophrenia who had been stabilized on their antipsychotic medication and subsequently maintained on it for a period of at least 18 months were identified: clozapine (N=15); risperidone (N=15); depot conventional (N=18); oral conventional (N=18). 2. Groups were compared on a clinical measure as well as the use of various health care services: hospitalizations; days in hospital, emergency room visits; physician and non-physician visits. 3. No differences between groups were found for hospitalizations, days in hospital, or emergency room visits, while physician and non-physician visits were highest in the clozapine group, in keeping with the need for routine hematologic monitoring in this population. The clozapine group had the highest baseline clinical scores and greatest number of previous hospitalizations. These treatment groups may reflect different clinical populations. However, the findings suggest that in drawing conclusions regarding long-term benefits of different agents, clinical or economic, it would prove useful to include in the evaluation a comparison of patients who have been stabilized on each of the treatments.     

Effectiveness of atypical antipsychotics for substance use in schizophrenia patients

OBJECTIVE: This study examined the influence of medication class (atypical antipsychotic, typical antipsychotic and no medication) and compliance on substance use outcomes for schizophrenia patients in the community. METHOD: N=362 adults with schizophrenia-spectrum disorder were followed for 3 years in a naturalistic study with structured interviews at 6-month intervals. Multivariable time-series analysis was performed using propensity-score adjustment for selection to medication class. RESULTS: Participants who were compliant with atypical antipsychotic medications for 90 days or more during each 6-month period were significantly less likely to use substances during the next 6-month period than patients who were compliant with typical antipsychotics or those who were not prescribed either type of medication for at least 90 days. CONCLUSION: Atypical antipsychotics may offer an advantage in reducing substance use among schizophrenia patients. For patients to benefit from atypical antipsychotics, treatment should focus on enhancing compliance and integrating substance use treatment.     

The efficacy of atypical antipsychotics in the treatment of depressive symptoms, hostility, and suicidality in patients with schizophrenia

Depressive symptoms and syndromal depression commonly occur in patients with schizophrenia. Schizophrenia is also associated with aggression directed at self and others. For this article, the available literature regarding the efficacy of clozapine, risperidone, olanzapine, quetiapine, and ziprasidone in the treatment of depression, hostility, and suicidality in patients with schizophrenia was reviewed. These studies suggest that atypical antipsychotics may exert therapeutic effects on depression and hostility as well as psychosis and that clozapine and olanzapine may reduce suicidality in patients with schizophrenia. These therapeutic actions appear to represent additional advantages of atypical antipsychotics compared with standard agents.     

A topographic event-related potential follow-up study on 'prepulse inhibition' in first and second episode patients with schizophrenia.

Dopamine agonists impair and antagonists normalize prepulse inhibition (PPI) of startle and gating of the P50 event-related potential (ERP), but the within-subject effect of treatment on impaired gating in schizophrenia has not been studied. We report the first results of a longitudinal study using PPI of ERPs as a measure of sensory gating in an auditory Go/NoGo discrimination. After admission and approximately 3 months later, at discharge, 15 patients with schizophrenia performed a discrimination between a 1.4 kHz target tone and an 0.8 kHz non-target tone with no prepulse, or with a prepulse at 100 ms or 500 ms before either tone. ERPs were recorded from 19 sites. Healthy subjects were studied twice, with 3 months between sessions. PPI of the P50 peak in the 100-ms condition was reduced in patients on admission. At discharge, decreased negative symptoms correlated with enhanced P50-PPI at frontocentral sites. After treatment increased N100-PPI at centrotemporal sites correlated with fewer positive symptoms. At frontal sites in the 100-ms condition, the initially small difference of non-target minus target P300 amplitudes increased as negative symptoms decreased. It is concluded that weak auditory prepulses interfere with early auditory stimulus processing (P50), channel selection (N100) and selective attention (P300). Gating of these stages of processing is impaired in psychotic patients and treatment tends to normalize gating in tandem with improvements of different types of symptoms.