住院未成年精神疾病患者抗精神病药物使用情况调查

目的调查2018年广州医科大学附属脑科医院住院未成年精神疾病患者抗精神病药物使用情况。方法通过电子住院信息系统收集2018年广州医科大学附属脑科医院所有住院年龄≤18岁且确诊为精神疾病的患者的临床、人口学和出院当日使用抗精神病药物情况,进行统计和分析。结果共入组626例未成年精神疾病患者,出院时93例(14.9%)患者未使用抗精神病药物,92例(14.7%)患者接受两种抗精神病药物联合治疗,441例(70.4%)患者使用一种抗精神病药物治疗;双相障碍(233例)、抑郁症(124例)、精神分裂症(108例)是诊断频率最高的三种精神疾病,其抗精神病药物使用率为别为94.0%、74.2%和99.1%。使用频率最高五种抗精神病药物依次为喹硫平、奥氮平、阿立哌唑、利培酮和帕利哌酮;双相障碍和抑郁症使用频率最高的抗精神病药物为喹硫平,精神分裂症最常使用奥氮平;儿童组患者最常使用阿立哌唑,青少年组患者最常使用喹硫平;男性患者最常使用奥氮平,女性患者最常使用喹硫平。儿童组患者阿立哌唑、利培酮和喹硫平剂量显著低于青少年组,男女两组间抗精神病药物剂量无显著差异。结论大部分住院未成年精神疾病患者在出院时接受单种抗精神病药物治疗,不同诊断抗精神病药物使用种类不同,不同年龄组抗精神病药物使用种类、剂量不同。     

北京安定医院住院儿童青少年精神疾病患者抗精神病药临床使用情况分析

目的:调查北京安定医院住院的儿童青少年精神疾病患者抗精神病药使用情况。方法:回顾分析住院年龄≤18岁患者出院当日使用抗精神病药情况。结果:共有1 827例患者入组,其中1 621例出院当日处方有抗精神病药;位于处方频率前5依次为喹硫平、奥氮平、阿立哌唑、利培酮、帕利哌酮缓释片/氨磺必利;双相障碍与抑郁发作使用频率最高的抗精神病药为喹硫平,精神分裂症和精神发育迟滞伴发精神障碍为奥氮平,起病于童年和青少年的情绪和行为问题为阿立哌唑;喹硫平、奥氮平、利培酮用药剂量青少年患者显著高于儿童患者,男性患者显著高于女性患者(P0.05或P0.01);阿立哌唑使用呈逐年上升趋势,奥氮平呈逐年下降趋势。结论:儿童青少年精神疾病住院患者的抗精神病药处方主要为非典型抗精神病药,不同年龄、性别用药剂量不同,阿立哌唑的处方频率呈上升趋势。     

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。     

非典型抗精神病药:糖代谢紊乱和代谢综合征

1介绍 自从非典型抗精神病药(atypical antipsychotics,AAP)如氯氮平、利培酮、奥氮平、奎硫平、齐哌西酮及阿立哌唑问世以来,这些药物已被广泛用于精神分裂症及其它精神病性障碍或严重行为障碍患者,这部分是由于有证据提示其对精神分裂症的阳性、阴性症状和认知症状有效,并且锥体外系反应(extrapyramidal symptoms,EPS)或迟发性运动障碍(tardive dyskinesia,TD)的发生倾向较其它神经抑制剂低(Jeste et al.,1997).     

258例儿童青少年精神分裂症住院患者药物治疗现状

目的了解儿童青少年精神分裂症患者药物治疗现状。方法调查2010年1月~2015年12月在我院住院的258例儿童青少年精神分裂症患者的药物治疗情况。结果单用非典型抗精神病药物186例(72.1%),两种抗精神病药物联用72例(27.9%)。单用利培酮66例(25.6%),奥氮平56例(21.7%),阿立哌唑35例(13.6%)。男性使用利培酮多于女性、使用阿立哌唑少于女性,差异有统计学意义(χ~2=9.905,8.380,均P0.01)。合用抗抑郁剂48例(18.6%),合用情绪稳定剂16例(6.2%),合用苯二氮卓类药物(BZD)32例(12.4%),不同性别、年龄比较差异无统计学意义(χ~2=0.016~1.482,均P0.05)。结论儿童青少年精神分裂症患者药物治疗以单用非典型抗精神病药物为主。使用利培酮和阿立哌唑存在性别差异,少部分患者联合两种抗精神病药物,部分患者合用抗抑郁剂、情绪稳定剂和BZD。     

5种新一代抗精神病药治疗首发精神分裂症的对照研究

目的比较利培酮、喹硫平、奥氮平、阿立哌唑和齐拉西酮治疗首发精神分裂症的疗效、可接受性及安全性。方法将200例首发精神分裂症患者随机给予上述5种之一的新一代抗精神病药治疗;采用《简明精神病量表》评定临床疗效,同时比较5种抗精神病药物的可接受性(合并用药率、换药率及维持原药率)和不良反应。结果 1临床疗效:阿立哌唑、利培酮、喹硫平、奥氮平、齐拉西酮治疗首发精神分裂症患者后BPRS评分较治疗前差异均有统计学意义(P0.01);经方差分析和LSD检验提示,利培酮组BPRS减分率显著高于阿立哌唑组(P0.01)和奥氮平组(P0.05)。2可接受性比较:经χ2检验提示(χ~2=15.55,P=0.049);经过分割χ2检验,奥氮平较阿立哌唑、齐拉西酮差异均有统计学意义(P0.05);同时喹硫平较齐拉西酮差异也有统计学意义(P0.05)。3不良反应比较:在锥体外系反应、ECG改变、肝功能异常、便秘、白细胞减少5个方面差异均无统计学意义(均P0.05)。结论 5种新一代抗精神病药治疗精神分裂症首次发病患者疗效均较好,奥氮平、喹硫平可接受性较好;5种药物之间不良反应类似。     

非典型抗精神病药对男性精神分裂症患者勃起功能及血浆催乳素水平的影响

目的:探讨非典型抗精神病药(AAP)对恢复期男性精神分裂症患者勃起功能及血浆催乳素(PRL)水平的影响。方法:采用国际勃起功能指数-5问卷(IIEF-5)对以氯氮平、喹硫平、奥氮平、利培酮、阿立哌唑、氨磺必利、帕利哌酮及齐拉西酮单一治疗≥6个月、具有稳定性伴侣的恢复期男性精神分裂症患者各30例进行总体勃起功能障碍(ED)评定,以IIEF-5≤21分定义为ED;同时采用放免法检测患者的血浆PRL水平。结果:ED发生率氨磺必利组显著高于氯氮平组、喹硫平组及阿立哌唑组(P均0.001),利培酮组显著高于阿立哌唑组(P0.01)。血浆PRL水平氨磺必利组、齐拉西酮组及利培酮组显著高于氯氮平组、喹硫平组、奥氮平组及阿立哌唑组(P均0.001),帕利哌酮组显著高于阿立哌唑组(P0.001)。IIEF-5评分与全部患者及氨磺必利组、帕利哌酮组和齐拉西酮组血浆PRL水平呈正相关(P均0.001)。结论:AAP中氨磺必利较易导致ED,利培酮次之;且氨磺必利、齐拉西酮及利培酮可能导致血浆PRL水平增高。     

奥氮平、奎硫平与阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素水平的影响

目的:探讨非典型抗精神病药奥氮平、奎硫平、阿立哌唑对精神分裂症患者血清甲状腺激素和催乳素(PRL)水平的影响方法:将150例精神分裂症患者随机分为奥氮平、奎硫平及阿立哌唑组并接受相应的药物治疗8周。治疗前后分别检测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(T3)、总甲状腺素(T4)、促甲状腺激素(TSH)及PRL水平。结果:治疗后3组血清FT4、T3、T4水平较治疗前明显下降(P均0.01);T4组间主效应有统计学意义(P0.05);治疗后奎硫平组血清T4水平较奥氮平组下降更明显(P0.05);治疗后奥氮平组血清PRL水平明显高于治疗前及奎硫平及阿立哌唑组(P均0.01),并具有交互作用(P0.01)。结论:奥氮平、奎硫平、阿立哌唑都降低甲状腺激素水平,奎硫平更易降低T4水平;奥氮平显著影响血清PRL水平。     

阿立哌唑与奎硫平治疗首发精神分裂症对照分析

目的:评价阿立哌唑与奎硫平对治疗首发精神分裂症患者的有效性和安全性。方法:对85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:阿立哌唑能有效治疗首发精神分裂症的阳性症状及阴性症状,疗效与奎硫平相当,不良反应较奎硫平更少。结论:阿立哌唑是一种有效而安全的新型抗精神病药。     

住院精神分裂症患者抗精神病药使用现状

目的调查2010年7所精神疾病专科医院住院精神分裂症患者抗精神病药(APD)使用现状。方法以2010年7月12至14日为时点调查日,对全国5省市7所精神疾病专科医院的1024例精神分裂症住院患者使用自制调查表进行APD使用的现况调查。结果 (1)1024例患者中,男652例(63.7%),女372例(36.3%)。(2)1010例(98.6%)患者接受了APD治疗,药物使用频率依次为:利培酮378例次(36.9%)、氯氮平295例次(28.8%)、奎硫平118例次(11.5%)、阿立哌唑101例次(9.9%)、氯丙嗪78例次(7.6%)齐拉西酮64例次(6.3%)、奋乃静59例次(5.8%)、奥氮平59例次(5.8%)、舒必利56例次(5.5%)。(2)非典型APD的使用频率为87.7%;典型APD的使用频率为22.8%;3.03%的患者接受了长效药物治疗。(3)72.36%的患者接受了单一抗精神病药治疗;26.27%的患者联合使用2种或2种以上APD。(4)合用药物主要是抗胆碱能药(25.00%)、苯二氮类药物(20.61%)、β-受体阻滞剂(19.34%)和心境稳定剂(11.72%),主要用于控制不良反应或增效治疗。结论非典型APD已经成为我国治疗精神分裂症的主流药物,APD的使用比较合理规范,但尚有不足。     

Does routine screening for benzodiazepines help to diagnose dependence in psychiatric inpatients?

After admission, 899 inpatients of a psychiatric university hospital were routinely screened for benzodiazepines (BDZ) in the urine. BDZ were detected in 134 (15%) patients with various primary diagnoses. Criteria for BDZ abuse or dependence were found in 36 patients. In 35 cases, either intake of BDZ had not been reported in the first psychiatric interview, or such a report had not been documented in the patient's charts. None of these 35 patients was found to have BDZ abuse or dependence. Psychiatric inpatients with BDZ abuse or dependence seem to report their intake of BDZ. These findings suggest that a routine screening for BDZ can hardly help to diagnose dependence within a university hospital setting. Nevertheless, an objective test for intake of BDZ may be useful in special cases.     

Difficulties in assessing adverse drug reactions in clinical trials

1. The discovery of an adverse drug reaction (ADR) depends on: the relative frequencies of the drug-related and non-drug events; the mechanism of drug-induced toxicity; the number of patients exposed to the drug; and the methods used for detecting toxicity. Clinical trials are usually short-term studies conducted in a few hundred patients before marketing a drug. Therefore only the most common acute, dose-related ADRs are usually detected in the pre-marketing phase. 2. The detection and assessment of ADRs in clinical trials is still inadequate. Unstructured (open-ended questionnaires) and structured procedures (checklists) are the methods most commonly used. Since both methods have limitations, the discovery of ADRs in pre-marketing trials (phases I to III) should also rely on the complementary information provided by other methods: physiological and physical examinations, and pertinent laboratory tests. A more definite assessment of individual cases of ADRs should include the use of the adverse drug reaction probability scale (APS) or similar procedures. 3. Because the knowledge on the clinical toxicity of a drug will always be incomplete at the time of marketing, further investigation of the frequency and determinants of ADRs must be pursued in the post-marketing phase.     

Reduction of Two-Drug Therapy in Intractable Epilepsy

The effects of reducing two-drug treatment to single-drug therapy were studied prospectively in 36 patients with intractable complex partial seizures. In 30 patients (83%) this was possible without an increase in seizure frequency. In six patients (17%) the number of seizures was higher during single-drug therapy. The slow transfer was not complicated by unwanted withdrawal effects. The plasma concentration of the single drug was raised if necessary until clinical drug toxicity was observed. An improvement in seizure control was surprisingly noted in 13 patients (36%). In two patients seizures were completely controlled. In one patient a seizure reduction of 87% was observed. The number of patients with clinical side effects was similar during two-drug and single-drug therapy. The number of side effects was lower during single-drug therapy. Reduction of polypharmacy may be beneficial for patients with intractable epilepsy.     

Contribution of adverse drug reaction to admission rates in an acute psychiatric ward

The relative contribution of adverse drug reactions (ADR) to the admission rate of an acute psychiatric ward was examined prospectively. Among 321 patients hospitalized over a period of 17 months, adverse drug reactions were the main cause for hospitalization in 7.5%. Extrapyramidal side effects - mainly resistant akathisia - account for half of these patients. The population at high risk was that of the elderly and those suffering from organic brain syndromes.     

Use of Saliva in Home Monitoring of Carbamazepine Levels

Summary: Total carbamazepine (CBZ) levels in serum of 61 epileptic children were compared with saliva levels. Both resting and stimulated saliva was analyzed. The salivary levels were 38.6% of serum CBZ levels. A highly significant correlation was noted ( r = 0.89, p < 0.001). Stimulation had no effect on saliva CBZ levels ( r = 0.97). Salivary and serum CBZ levels were not affected by storing the samples for 7 days at room temperature. The data indicate that salivary CBZ may provide a reliable alter-native monitoring method to Tegretol therapy, especially in children, in whom blood sampling is difficult. Further-more, the samples may be collected at home and delivered to the laboratory by mail.     

Adverse drug reactions. An epidemiological study at psychiatric hospitals

A drug monitoring system has been established at psychiatric university hospitals in Berlin, Goettingen, and Munich since 1979 in order to investigate adverse reactions to psychotropic drugs. This report describes the system and presents results obtained over 3 years. 504 randomly selected patients were observed by Intensive Drug Monitoring; 75% of them had an adverse drug reaction (ADR) during hospitalization that was assessed as possible, probable, or definite including all grades (I-III) of severity. 5,096 other patients were monitored by Organized Spontaneous Reporting during treatment with psychotropic drugs: ADRs were responsible for drug withdrawal (severity grade III) in about 10% of them. Parkinsonism, psychomotor disturbance, akathisia, delirium, oversedation and increased transaminases were the most frequent ADRs of this kind. The relative frequency of ADRs was calculated, and ADR-profiles established for drugs most frequently withdrawn. The impact of ADRs on ongoing therapy of patients was assessed. Reliable data obtained by drug monitoring systems can be expected to aid in therapeutic decisions in patients with special risks of side effects to psychotropic drugs.