非典型抗精神病药的临床应用评价

以氯丙嗪为代表的典型抗精神病药在二十世纪六十年代开始使用时,是一种能有效控制精神病症状的药物,治疗精神分裂症很有效.虽然它们在药效和化学组成上有很大的差别,但也具有很多共同点.它们的药理学作用是阻断多巴胺D2受体.疗效包括控制严重的精神病症状,减少攻击性行为,缓解严重的焦躁,降低精神分裂症和其它精神病患者在维持治疗期间病情复发的危险.所有的典型抗精神病药都会产生锥体外系副作用,因此它们被称为精神抑制药[1].     

非典型抗精神病药治疗精神分裂症的临床应用评价

精神分裂症作为一组严重的精神疾病影响了全球约1％的人口。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。尽管精神分裂症的病因迄今未明,但在抗精神病药物的帮助下,精神分裂症的治疗在过去五十年有了长足进步。本文对非典型抗精神病药物概念、在精神分裂症中的临床应用评价等文献进行综述,以便为临床应用提供参考。     

新型非典型抗精神病药齐拉西酮

通过文献检索综述了齐拉西酮的作用机制、药代动力学及临床评价。齐拉西酮是一种安全、有效的非典型性抗精神病药，用于治疗精神分裂症和分裂情感性障碍。     

非典型抗精神病药治疗700例精神分裂症住院患者的应用分析

目的：了解我院精神分裂症住院患者非典型抗精神病药的应用现状,探讨临床使用非典型抗精神病药的特点。方法：随机抽查本院2008年住院的700例诊断为精神分裂症患者应用非典型抗精神病药,采用WHO药物统计合作中心设定的限定日剂量（DDD）计算我院非典型抗精神病药的用药频度（DDDs）、药物利用指数（DUI）及联合用药情况。结果：非典型抗精神病药的DDDs排序为：喹硫平、利培酮、氯氮平、阿立哌唑、齐拉西酮、奥氮平。单一药物治疗496例,占70.86%;二联或三联用药204例,占29.14%。DUI≤1。结论：我院非典型抗精神病药用药结构倾向合理。对于精神分裂症的临床治疗应以单一药物治疗为主。     

新型非典型抗精神病药:伊潘立酮

针对目前抗精神病药物依从性差、不能耐受和频繁换药等特点,开发更加安全有效的新型抗精神病药物成为一项具有挑战性任务。伊潘立酮作为一种新型非典型抗精神病药物,主要拮抗5-羟色胺2A受体(5-HT_2A)和多巴胺-2受体（D₂）,用于成人精神分裂症的治疗。就目前临床研究资料显示,该药安全有效,主要特点为锥体外系不良反应（EPS）少,代谢异常和体质量增加的发生率较低,但可引起QT间期延长和直立性低血压。     

新型抗精神病药临床再评价

新型抗精神病药（Modern antipsychotics，MA）氯氮平自1988年进入临床后，以不良反应特别是锥体外系症状少，对难治性急、慢性精神分裂症疗效显的特点，致使常规抗精神病药（Conventional antipsychoties，CA）如吩噻嗪类（氯丙嗪等）、噻吨类（如氯普噻吨）和丁酰苯类（如氟哌啶醇）的治疗地位下降。近年来，奥氮平、喹硫平、利培酮、齐拉西酮、阿立哌唑等MA上市，其化学结构、药理机制和用途各不相同，但均在临床得以广泛应用并受到推荐。本综合新近研究，对MA与CA的有效性、安全性进行比较。     

非典型抗精神病药物用于精神分裂症康复期治疗

精神分裂症是一组病因尚未明确的精神疾病,患者具有思维、情感和行为等多方面障碍及精神活动不协调。精神分裂症康复期治疗以药物治疗为基础,旨在减少病情的反复。目前,非典型抗精神病药物(SGA)为精神分裂症一线治疗药物。本文就近年SGA在精神分裂症康复期治疗中的研究进展作一综述。     

新型抗精神病药的研发进展

现存的各类抗精神病药物的不良反应繁多，且控制症状的效能仍有很大局限，致使相当数量的患者成为难治性案例。本文对近年国外研究出的新型药物的进展进行系统探讨，以期提高现有治疗水平。     

Quetiapine has a direct effect on the negative symptoms of schizophrenia

Second-generation 'atypical' antipsychotics appear to be more effective than first-generation 'typical' antipsychotics in improving negative symptoms in schizophrenia; it is unclear, however, if this greater improvement represents a direct beneficial effect or is mediated indirectly by an antidepressant effect or the absence of extrapyramidal symptoms (EPS). To address this issue with reference to quetiapine ('Seroquel'), data were evaluated from four randomized, controlled clinical studies involving 1106 patients employing a path analysis model. The total effect of quetiapine on negative symptoms was measured using the Scale for Assessment of Negative Symptoms (SANS) total score. Indirect effects on negative symptoms via positive, depressive and EPS were assessed using appropriate instruments. Effect sizes were calculated by path analysis for the difference between treatment groups in change from baseline to endpoint in SANS total score. Analysis confirmed that quetiapine produced a greater overall improvement in negative symptoms than placebo (effect size 1.96); this was explained by a significant direct effect (p = 0.001; 44.2% of total improvement), and a secondary effect of improved positive symptoms (p < 0.001; 47.5% of total improvement), but was not a consequence of changes in depressive symptoms or EPS. Within the constraints of the path analysis methodology, these results indicate that quetiapine has a substantial direct effect on improving the negative symptoms of schizophrenia.     

非典型抗精神病药物在儿童多发性抽动障碍治疗中的研究进展

多发性抽动障碍（TS）是儿童期常见的神经精神疾病,临床特征表现为运动性抽动和发声性抽动,抽动症状在青春期后有所改善,但部分患者可能出现抽动相关的共患病。在传统治疗措施失败,且某些精神合并症使临床表现复杂化时,非典型抗精神病药物成为治疗TS的新选择。然而,非典型精神病药物治疗TS的研究证据比较有限。研究证据显示,非典型性抗精神病药物广泛应用于TS的治疗,其中利培酮是研究证据相对充足的有效药物,阿立哌唑是治疗TS具有较好前景的药物,齐拉西酮、奥氮平与喹硫平能改善抽动症状,但随机对照试验缺乏,有待进一步研究证实。甲氧氯普胺和氯氮平研究证据缺乏,且副作用明显,不推荐用于治疗TS。     

Efficacy and Safety Considerations With Second-Generation Antipsychotics as Adjunctive Analgesics: A Review of Literature

Objective: To determine the efficacy and safety of second-generation antipsychotics (SGAs) as adjunctive analgesics. Data Sources: A comprehensive literature review was conducted between August 2020 and January 2021 on PubMed, Scopus, and ProQuest Central. Study Selection and Data Extraction: Keyword and Boolean phrase searches using the following terminology were conducted: “Quetiapine” OR “Risperidone” OR “Olanzapine” OR “Ziprasidone” AND “Analgesia” NOT “Psychosis” NOT “Psych.” Articles that involved human adult patients who received any of the SGAs mentioned in the searching filter with an opioid were included. Articles that described pediatrics, pregnant women, patients who received any of these agents for treatment of psychosis and articles that were not in English, or readily translatable to English, were excluded. Data Synthesis: Three articles were selected for inclusion in this review, with 2 articles detailing reports with olanzapine and 1 article describing a randomized, controlled trial with extended-release quetiapine. Both olanzapine and quetiapine were able to decrease pain scores on the numeric rating scale, indicating a reduction pain experienced, and additionally reduced opioid craving behavior in patients. Depression scores and quality-of-life indicators improved with quetiapine, though those metrics were not studied with olanzapine. Conclusions: Select SGAs, specifically extended-release quetiapine and olanzapine, may serve as an appropriate adjunctive analgesic choice in select patients. Further research is required in a clinical setting to determine the exact role of this drug class in pain management.     

三种非典型抗精神病药物对首发女性分裂症患者的疗效及不良反应的对照研究

OBJECTIVE To explore the differences of three atypical antipsychotics on efficacy and side effects in first-episode female schizophrenic patients.METHODS 163 first-episode female schizophrenic patients were randomly recruited into resperidone,quetiapine a     

第2代抗精神病药治疗双相障碍的临床疗效评价

目的:评价第2代抗精神病药治疗双相障碍的临床疗效。方法:查阅国内外近年文献,对第2代抗精神病药治疗双相障碍的进展和临床应用进行评价。结果与结论:第2代抗精神病药治疗双相障碍单药治疗和附加治疗具有良好效果。其特点起效快,具有控制躁狂,缓解抑郁,改善精神病性症状作用,不良反应少,耐受性和安全性好。因此,第2代抗精神病药可作为治疗双相障碍的一线首选药之一。     

非典型抗精神病药物治疗双相抑郁

双相抑郁是双相障碍的一种发作形式,临床治疗困难。非典型抗精神病药物具有心境稳定作用,目前主要用于治疗双相躁狂,但对双相抑郁的治疗尚有争议。部分非典型抗精神病药物治疗双相抑郁有效。     

联用帕罗西汀治疗难治性精神分裂症临床观察

目的 :观察抗精神病药联用小剂量帕罗西汀治疗难治性精神分裂症阴性症状的疗效和不良反应。方法 :对35例难治性精神分裂症病人在原有抗精神病药物治疗的基础上 ,加用帕罗西汀 2 0 mg。采用简明精神病学量表 (BPRS)、阴性症状量表 (SANS)和不良反应症状量表 (TESS) ,于联合用药前和联用后 2、4、8周末 ,分别进行评分。并同时检查血、尿常规及生化、心电图。结果 :35例病人均完成 8周的治疗。按研究结束时 SANS减分率判定 ,无效 15例 (42 .9%) ,有效16例 (45 .7%) ,显效 4例 (11.4%)。联合用药 8周后 ,BPRS、SANS总分及其中几项因子分均比合用前显著降低 (P <0 .0 5或 0 .0 1) ,而 TESS评分联合用药前后无显著性差异 (P>0 .0 5 )。结论 :抗精神病药物联用小剂量帕罗西汀 ,可改善难治性精神分裂症病人的阴性症状 ,且少有不良反应。     

第二代抗精神病药安全性评价

目的：评价第二代抗精神病药临床应用的安全性。方法：检索国内外近年文献，对第二代抗精神病药的安全性进行评价。结果与结论：本文重点比较氨磺必利、阿立哌唑、氯氮平、奥氮平、喹硫平、利培酮、舍廷多、齐拉西酮和佐替平9种第二代抗精神病药的安全性。并对这些药物在代谢综合征、高催乳素血症、QTc间期延长、增加死亡率风险、粒细胞减少症、癫痫发作的影响风险进行评价。