奥氮平与氯氮平治疗兴奋激越症状的成本-效果分析

目的 比较奥氮平与氯氮平治疗兴奋激越症状的成本-效果. 方法 有兴奋症状的精神患者60例分成两组, 治疗组30例, 奥氮平15～30 mg•d^-1, 对照组30例, 氯氮平150～400 mg•d^-1, 观察2周, 并以治疗前后简明精神病量表（BPRS）激越分减分率评定疗效, 以不良反应量表评定安全性, 作药物经济学评价. 结果 两组在1和2周末BPRS激越分均较疗前显著下降, 治疗组2周有效率为76.7%, 对照组有效率为72.4%. 治疗组不良反应较对照组少. 对照组成本明显低于治疗组. 结论 奥氮平与氯氮平治疗急性期兴奋激越患者疗效均肯定, 但奥氮平成本比氯氮平高.     

小剂量奥氮平快速治疗急性脑卒中兴奋激越症状的临床观察

目的为了探讨小剂量奥氮平快速控制急性脑卒中兴奋激越症状的临床疗效与安全性。方法随机选择30例具有明显兴奋激越症状的急性脑卒中病人,给予小剂量奥氮平（2．5mg-5mg）快速治疗1周。以治疗前后简明精神病量表（BPRS）激越分的减分率评定疗效,以副反应量表（TESS）及心电图及肝肾功能评价安全性。结果小剂量奥氮平治疗有效率100．0％,显效率66.3％,副反应量表、心电图、肝肾功能前后无差异。结论小剂量奥氮平对急性脑卒中兴奋激越症状的治疗有效,且快速,安全性高。     

奥氮平与氯氮平治疗精神分裂症的临床对照研究

目的探讨精神病障碍的治疗方法。方法应用诊断标准及工具量表和血样本的实验室分析方法进行评估。结果 88例符合标准的患者纳入研究,奥氮平组患者服药的最小剂量为5mg/d,最大剂量15mg/d,平均(8.75±2.63)mg/d;氯氮平组患者的最小剂量125mg/d,最大剂量为500mg/d,平均为(305±88.4)mg/d。结论奥氮平是治疗精神病的有效药物。     

奥氮平联合利培酮治疗伴激越症状的精神分裂症的临床观察

目的 研究奥氮平+利培酮运用于伴激越症状的精神分裂症中的价值。方法 选取我院收治的伴激越症状的精神分裂症患者70例，随机分为研究组和对照组，各35例。研究组采取奥氮平+利培酮，对照组服用奥氮平，对比两组的总有效率、阳性和阴性症状量表(PANSS)、兴奋量表(PANSS-EC)、不良反应，比较两组用药结果。结果 研究组总有效率高于对照组(P<0.05)。服药前各组的PANSS评分并差别(P>0.05),服药后研究组阳性症状、阴性症状、一般精神病性评分、、总分均低于对照组(P<0.05)。服药前各组的PANSS-EC评分并差别(P>0.05),服药后3d、1周、2周研究组评分均低于对照组(P<0.05)。研究组不良反应发生率少于对照组(P<0.05)。结论 奥氮平+利培酮的疗效更为理想，能够促进患者症状减轻，尤其是激越症状，从而稳定病情，值得推广。     

奥氮平与氯氮平治疗老年痴呆精神症状的对照研究

目的 比较奥氮平和氯氮平治疗老年期痴呆患者精神行为症状的疗效及安全性.方法 将符合条件的76例老年痴呆伴有精神行为障碍的患者随机分为奥氮平组和氯氮平组,(各38例),治疗8周.于治疗前及治疗后第2、4、8周分别采用阿尔茨海默病病理行为评分表(BEHAVE-AD)药物不良反应量表(TESS)评定疗效和不良反应.结果 两组BEHAVE-AD评分治疗前后比较均有显著性差异(P均<0.05),两组间BEHAVE-AD评分治疗在不同时间均无显著性(P>0.05).2、4、8周时奥氮平组的TESS评分明显低于氯氮平组,两组间差异有显著性(P<0.05),奥氮平组不良反应较氮氮平组少.结论 奥氮平和氮氮平对治疗老年期痴呆患者精神行为障碍的疗效相似.奥氮平的不良反应低于氯氮平,更适应于老年患者的治疗.     

奥氮平合用奥卡西平治疗精神分裂症伴兴奋激越患者的临床疗效观察

目的：观察奥氮平合用奥卡西平治疗精神分裂症伴兴奋激越患者的临床疗效。方法：将180例精神分裂症伴兴奋激越患者随机分成单用组和合用组,分别在治疗前、1周末、2周末进行修改版外显攻击行为量表（MOAS）、PANSS量表评定。结果：单用组2周末总有效率为68．89％,联用组为81．11％,经X^2检验有统计学意义（X^2=2．68,P〈0．05）;1周末单用组、联用组MOAS因子分别与治疗前比较,差异有统计学意义（P〈0．05）;联用组与单用组1周末比较,差异有统计学意义（P〈0．05）;2周末两组MOAS因子分比较有显著性差异有统计学意义（P〈0．01）;2周末两组TESS评分经t检验差异无统计学意义（P〉0．05）。结论：奥氮平合用奥卡西平治疗精神分裂症伴兴奋激越患者起效快、疗效好,值得临床推广使用。     

奥氮平与氯氮平治疗难治性精神分裂症对照研究

目的探讨奥氮平与氯氮平治疗难治性精神分裂症的疗效比较。方法选取奥氮平与氯氮平组,两组间比较差异无统计学意义,并且按照规范性用药。结果两组显示PANSS评定8月末与治疗前比较,在总分、阳性分、阴性分改善方面均有极其显著差异(P均<0.01)。结论奥氮平有良好的临床实用价值。     

奥氮平与氯氮平治疗难治性精神分裂症的对照研究

目的探讨奥氮平(悉敏)治疗难治性精神分裂症的疗效与安全性。方法将65例难治性精神分裂症患者随机分为两组(试验组34例,对照组31例),分别予奥氮平(悉敏)和氯氮平治疗,疗程12周,用阳性症状和阴性症状量表(PANSS)评定疗效,用不良反应量表(TESS)评定不良反应。结果奥氮平(悉敏)治疗有效率为47.1%,氯氮平为45.2%,两组总体疗效比较无统计学差异(P>0.05),但奥氮平(悉敏)不良反应较少而轻。结论奥氮平(悉敏)治疗难治性精神分裂症和氯氮平疗效相当,且安全性高。     

奥氮平与氯氮平治疗难治性精神分裂症的对照研究

目的观察奥氮平治疗难治性精神分裂症的临床疗效及不良反应。方法将70例临床诊断为难治性精神分裂症的患者随机分为2组,分别用奥氮平与氯氮平治疗4个月,用简明精神病评定量表(BPRS)及副反应量表(TESS)评定疗效及副反应。结果奥氮平组疗效高于氯氮平组,且无严重的不良反应。结论奥氮平是治疗难治性精神分裂症安全有效的药物,适合临床应用。     

奥氮平与氯氮平对脑电图影响的对照观察

目的 对精神分裂症患者运用奥氮平与氯氮平对脑电图影响的对照观察,选取治疗效果较好的药物应用与临床.方法 根据随机性原则选取从2014年1月～2016年12月期间在我院住院治疗的精神分裂症患者98例,将98例确诊为精神分裂症患者作为临床研究对象,随机盲法分为两组,对照组49例,观察组49例,对照组精神分裂症患者采取氯氮平进行治疗,观察组精神分裂症患者采取奥氮平进行治疗,治疗后根据两组患者脑电图的变化情况进行分析,总结对精神分裂症患者治疗效果较好的药物.结果 服药后2周和服药后8周奥氮平的患者脑电图正常率高于氯氮平组,两组患者比较差异显著,具有统计学意义,P＜0.05.结论 精神分裂症患者奥氮平与氯氮平对脑电图影响的对照观察发现,奥氮平对精神分裂症患者脑电图影响较小,说明奥氮平安全性很好,因此在临床治疗中选用奥氮平较为合适.     

Fever development in neuroleptic malignant syndrome during treatment with olanzapine and clozapine

Neuroleptic malignant syndrome (NMS) is the most dangerous life-threatening complication of antipsychotic medication. It's development is connected with the blockade of dopaminergic transmission (D₂ receptors) in the nigrostriatal system of the brain. Fever is one of the main symptoms of this syndrome and it's elevation is due to the activation of the immune system. Numerous studies report that treatment with clozapine (doses 37.5–600 mg) or olanzapine (doses 10–25 mg) or the use of these drugs in polytherapy cause pyrexia between 37.8–40.6°C. Additionally, levels of proinflammatory interleukins such as IL-6, IL-1,TNF-α were increased. The aim of this article is to describe how olanzapine and clozapine influence fever development in NMS, in relation to the dose of the drug taken by schizophrenic patients including changes in immunological system.     

An observational study of the effectiveness and safety of intramuscular olanzapine in the treatment of acute agitation in patients with bipolar mania or schizophrenia/schizoaffective disorder

OBJECTIVE: To determine the effect of intramuscular (IM) olanzapine in severely agitated patients. METHODS: This was an open-label multicenter 1-week observational study of IM olanzapine treatment in severely agitated inpatients and psychiatric emergency services with bipolar mania (n = 22) or schizophrenia (n = 52). Mean change from baseline to 2 h post-first injection (LOCF) in agitation was assessed by PANSS-Excited Component (PANSS-EC) (score range: 5-35 points) mean change from baseline to 15, 30, 45, 60, 90, and 120 min post-first injection, and visit-wise mean changes from mixed-model repeated measures analysis of variance. Kaplan-Meier survival curve analyses estimated time to categorical response (rating of 相似文献   

Comparison between risperidone, olanzapine, and clozapine in the management of chronic schizophrenia: a naturalistic prospective 12-week observational study

Risperidone, olanzapine, and clozapine are three atypical antipsychotic medications commonly used in the management of chronic schizophrenia. While they offer advantages with regard to clinical efficacy and side-effect profile, few studies have compared them in a naturalistic prospective observational manner. This study therefore investigated their comparative efficacy over 12 weeks including illness characteristics and adverse effects. One hundred thirty-one patients (76 M, 55 F) with DSMI-V schizophrenia or schizoaffective disorder were treated with risperidone (n = 38), olanzapine (n = 38), or clozapine (n = 55). All patients showed a significant decrease of Positive and Negative Syndrome Scale (PANSS)-positive scores. Decreases in tardive dyskinesia and impulsivity scores were noted with clozapine and olanzapine, respectively. No differences between the medications were noted on depression, anxiety, EPS, or overt aggression scores. Olanzapine and clozapine appeared to be more effective in females. Males showed a decreased sexual performance irrespective of the medication and those treated with risperidone and clozapine showed greater proportional reduction of overt aggression. Clozapine-treated patients showed significant increased weight, increased glucose levels, and lowered sexual performance. Risperidone patients tended to exhibit reduced cholesterol levels. Higher creatine kinase (CK) levels were noted in risperidone-treated patients. While cautious given the nature of the study design, results suggest differences in the response to various atypical antipsychotic medications regarding efficacy and side-effect susceptibility.     

Haematological toxicity of clozapine and some other drugs used in psychiatry

OBJECTIVE: To review recent work on the haematological toxicity of clozapine and some other drugs used in psychiatry concerning especially (i) the mechanism of antipsychotic-induced neutropenia/agranulocytosis, (ii) criteria for clozapine prescribing in benign ethnic neutropenia, (iii) options in the event of worrying falls in white cell count (WCC), including measures to boost WCC with or without continued clozapine administration, (iv) criteria for clozapine rechallenge in the event that treatment was suspended because of a fall in WCC and (v) safety concerns regarding clozapine in children/adolescents. CONCLUSIONS: There remain several difficult areas, including the criteria for clozapine rechallenge. Experience has emphasised (i) the role of appropriate timing of WCC sample collection to ensure that clozapine is not withdrawn unnecessarily and (ii) the success of agents such as filgrastim in promoting rapid production of granulocytes if the situation so demands. On the other hand, the use of lithium to promote a leucocytosis has taken hold without a clear risk: benefit analysis. Be this as it may, should patients decide that they no longer wish to undergo WCC monitoring after 12 months on clozapine, cessation of monitoring is probably preferable to stopping the drug since overall mortality is decreased in patients treated with clozapine.     

Plasma concentrations of high-dose olanzapine in a double-blind crossover study

Olanzapine is structurally similar to clozapine but has not been shown at routine doses to share the superiority of clozapine to traditional antipsychotics in treatment-resistant patients. Olanzapine, however, has been increasingly used in higher doses as clinicians attempt to find a more tolerable therapy for those refractory to conventional agents. This study examined the relationship of high-dose olanzapine plasma concentrations to symptoms, adverse effects, smoking, and gender. Thirteen patients participated in a double blind 16-week crossover study (8 weeks each arm) of olanzapine (50 mg/day) compared to clozapine (450 mg/day). Women had significantly higher plasma olanzapine levels than men at each time point in each arm (weeks 4, 6, and 8). At 8 weeks women had a steady-state olanzapine level of 278 +/- 62 ng/ml while men had a steady-state level of 127 +/- 47 ng/ml (p = 0.005). At week 4, olanzapine levels tended to be higher in those who had been on clozapine previously (205 ng/ml) compared to those who received olanzapine in the first arm (105 ng/ml). Cigarette intake was negatively correlated to olanzapine plasma concentrations (week 8: r = -0.86, p < 0.05). Plasma levels were significantly higher in those experiencing constipation (176 vs. 82 ng/ml; p = 0.022). Plasma levels of olanzapine were not associated with symptom response and anticholinergic effects were seen at greater frequency with higher olanzapine concentrations. In conclusion, this study reports plasma olanzapine levels at high fixed doses of olanzapine (50 mg/day) in relation to side effects, symptoms, smoking, and gender.     

利培酮口服液与奥氮平治疗脑器质性精神障碍疗效与安全性分析

目的:比较利培酮口服液与奥氮平在治疗脑器质性精神障碍疗效与安全性的差异.方法:分析2007年5月至2011年5月在本院住院4周以上,符合CCMD-3中脑器质性精神障碍诊断标准的患者共133例,其中利培酮口服液组62例,奥氮平组71例.比较两组患者入院时与治疗4周末在简明精神病评定量表、阳性症状量表、阴性症状量表、副反应量表总分以及实验室检查上的差异.结果:两组在治疗4周末简明精神病评定量表、阳性症状量表、阴性症状量表分值上无统计学差异(P＞0.05).在锥体外系副反应,催乳素水平升高上利培酮口服液组要大于奥氮平组(P＜0.05),而在体重增加和镇静、嗜睡上要少于奥氮平组(P＜0.05);在其余副反应项目的比较上则未见统计学差异(P＞0.05).结论:利培酮口服液与奥氮平对脑器质性精神障碍的治疗效果是相当的,对脑炎所致精神障碍的有效率在80％左右,两者在副反应上有所差别,在临床治疗时需根据患者具体情况制定个体化治疗方案.     

阿立哌唑治疗精神分裂症的疗效观察

目的探讨阿立哌唑治疗精神分裂症的疗效及不良反应。方法应用阿立哌唑对57例精神分裂症患者进行治疗,治疗剂量10～30mg/d,疗程为8周。于治疗前及治疗第2、4、8周后对患者进行随访,用阳性与阴性症状量表（BRPS）及不良反应量表（TESS）评定临床疗效与不良反应。结果阿立哌唑治疗精神分裂症有效率为91.3%,显效率为70.2%。治疗第2、4、8周后PANSS总分、阳性症状分、阴性症状分及一般精神病理分数均有明显下降,与治疗前比较差异有统计学意义（P〈0.05或P〈0.01）。主要不良反应为失眠、头晕及头痛。结论阿立哌唑治疗精神分裂症患者疗效佳,不良反应少,值得在临床上推广。     

奥氮平与齐拉西酮治疗青少年精神分裂症疗效的对比研究

目的比较奥氮平与齐拉西酮治疗青少年精神分裂症的疗效及其不良反应。方法将60例青少年精神分裂症患者随机平分为两组。以奥氮平和齐拉西酮治疗,疗程8周。采用阳性与阴性症状量表(PANSS)及治疗中出现的不良反应例数评定疗效以及不良反应。结果奥氮平和齐拉西酮治疗青少年精神分裂症患者总体疗效相当,两药不良反应均较小,但奥氮平在语言表达流畅性方面明显优于齐拉西酮;齐拉西酮的体重增加方面则低于奥氮平。结论奥氮平与齐拉西酮治疗青少年精神分裂症均有效,奥氮平在治疗精神分裂症患者的阴性症状效果更好。     

帕利哌酮缓释片与奥氮平治疗难治性精神分裂症的对照研究

目的:比较帕利哌酮缓释片与奥氮平对难治性精神分裂症的疗效及安全性。方法:将30例难治性精神分裂症患者随机分为帕利哌酮组[15例,(10.1±2.6)mg.d-1]和奥氮平组[15例,(14.6±5.8)mg.d-1],疗程为12周。采用阳性和阴性症状量表(PANSS)和治疗中需处理的不良反应症状量表(TESS),在治疗前及治疗第1,2,4,8和12周末分别评定疗效和不良反应。结果:①帕利哌酮组PANSS总分、阳性症状分及一般病理分从治疗第1周末起,阴性症状分从第2周末起较治疗前下降(P<0.05);奥氮平组PANSS总分、阳性症状分、阴性症状分及一般病理分均从治疗第2周末起较治疗前下降(P<0.05);两组PANSS总分及各因子分自第2周末起差异无统计学意义。②治疗第12周末,帕利哌酮组和奥氮平组临床总有效率分别为73%(11/15)和67%(10/15),差异无统计学意义。③帕利哌酮组和奥氮平组的不良反应发生率分别为47%(7/15)和53%(8/15),差异无统计学意义。其中,帕利哌酮组异常泌乳和(或)闭经发生率高于奥氮平组(P<0.05),奥氮平组体质量增加及糖耐量异常发生率高于帕利哌酮组(P<0.01)。结论:帕利哌酮缓释片对难治性精神分裂症疗效良好且不良反应轻微。     

利培酮和氯氮平治疗难治性精神分裂症的随机对照研究

目的:比较氯氮平和利培酮治疗难治性精神分裂症的疗效及不良反应.方法:共入组60例符合Kane难治性精神分裂症定义的患者,随机服用氯氮平200～400mg·d-1和利培酮4～8mg·d-1治疗,每组各30例,观察16周,分别于治疗前及治疗1,2,4,8,12,16周末评定阳性症状和阴性症状量表(PANSS)、治疗中不良反应评定量表(TESS)、功能总体评定量表(GAF)指标各1次.治疗前后还需评定韦氏记忆量表(WMS)和威斯康星卡片分类测验(WCST)各1次.结果:两组基线时各项指标包括用药剂量(折合成氯丙嗪)无差异(P均＞0.05).两组治疗第4周末GAF量表评分明显增加,治疗第8周末PANSS总分、阴性症状因子分明显降低,治疗第12周末PANSS总分及各因子分均明显降低,差异均有非常显著性.两组比较治疗第16周末利培酮组TESS量表评分明显低于氯氮平组(P=0.000),而GAF量表得分明显高于氯氮平组(P=0.000),差异均有非常显著性.结论:氯氮平和利培酮治疗难治性精神分裂症患者均有效,且利培酮的不良反应更轻,更利于患者社会功能的改善.