奥氮平与利培酮治疗精神分裂症对照研究

目的:比较奥氮平与利培酮治疗精神分裂症的疗效和安全性。方法:将60例精神分裂症随机分两组,分别给予奥氮平与利培酮治疗8周。用阳性与阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)评定疗效及不良反应。结果:奥氮平与利培酮的疗效差异无显著性。奥氮平主要不良反应是嗜睡、体质量增加,利培酮主要是锥外系反应、失眠。结论:奥氮平与利培酮均是治疗精神分裂症安全有效的非典型抗精神病药,可根据患者的情况分别选择。     

国产奥氮平与利培酮治疗伴激越的精神分裂症的对照研究

目的:观察国产奥氮平与利培酮治疗伴兴奋激越症状精神分裂症患者的疗效及安全性.方法:对63例首发或复发伴兴奋激越症状精神分裂症患者分为两组.奥氮平组31例,利培酮组32例,分别予国产奥氮平与利培酮治疗8周,并用阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS),及PANSS-兴奋激越5项目(PANSS-E...     

利培酮、奥氮平和喹硫平治疗未服药的精神分裂症患者的疗效和不良反应：1年自然观察研究

背景第二代抗精神病药被日益广泛地用于治疗精神分裂症首次发作,但其疗效是否一致尚有争议。假设利培酮、奥氮平、喹硫平治疗未服药的首次发病的精神分裂症或分裂样精神障碍患者,其1年的疗效是一致的。方法采用自然观察研究方法,对病程≤5年,符合ICD-10精神分裂症或分裂样精神障碍研究用诊断标准的未服药门诊患者随访1年。纳入398例患者,分别用利培酮（131例）、奥氮平（136例）、喹硫平（131例）单药治疗。在开始治疗后的第2周,2、3、6、8以及12个月时采用阳性与阴性综合征量表（Positive and Negative Syndrome Scale,PANSS）评估疗效,用副反应量表（Treatment Emergent Symptom Scale,TESS）评估治疗中出现的不良反应,非盲法评定。结果共269例（67%）患者完成1年随访。利培酮组、奥氮平组和喹硫平组的停药率分别为35.1%（46/131）、31.6%（43/136）和32.1%（42/131）,χ^2=0.43,P=0.809。对脱落患者的资料采用末次观察结转法,1年时利培酮组、奥氮平组和喹硫平组的PANSS总分平均值（标准差）分别减少46.8%（17.0%）,48.6%（19.6%）和47.3%（16.2%）,F=0.38,P=0.688。重复测量的方差分析显示,无论是PANSS总分还是分量表分,治疗各时点三组间差异均无统计学意义。治疗第2周时利培酮组发生震颤和静坐不能的比例高于其他两组。1年时,3组中常见的不良反应是体重增加和嗜睡,奥氮平组体重增加的比例（69.9%）高于其他两组。根据持续存在不良反应症状的时点数与总随访时点数的比值衡量不良反应的持续时间,锥体外系症状在利培酮组最明显,体重增加在奥氮平组最明显,心动过速在喹硫平组最明显。结论利培酮、奥氮平、喹硫平单药治疗未服药的精神分裂症或分裂样精神障碍患者1年疗效相似,但不良反应有所不同。     

Comparative effects of risperidone and olanzapine on cognition in elderly patients with schizophrenia or schizoaffective disorder

OBJECTIVE: To examine the effects of risperidone and olanzapine on cognitive functioning in elderly patients with schizophrenia or schizoaffective disorder. METHOD: One hundred seventy-six elderly inpatients and outpatients with schizophrenia or schizoaffective disorder were enrolled in this multicenter, double-blind trial. After their antipsychotic medications were tapered for 1 week, patients were randomly assigned to receive either risperidone 1 to 3 mg/day or olanzapine 5 to 20 mg/day for 8 weeks. Performance on the Continuous Performance Test (CPT), Serial Verbal Learning Test (SVLT), TMT (Trail Making Test) Parts A and B, Wisconsin Card Sorting Test (WCST), and Verbal Fluency Examinations (VFE) was assessed at baseline and at end point. RESULTS: Patients in the risperidone group had improved scores on at least one test of attention, memory, executive function, and verbal fluency, and those in the olanzapine group had improved scores on at least one test of attention and memory function. Scores on the TMT Part B, WCST total errors (executive function domain), and the VFE improved significantly from baseline in the risperidone group but not in the olanzapine group. No significant differences in change scores between the two groups were found. Higher baseline scores on each test predicted more improvement at endpoint. CONCLUSIONS: Low doses of risperidone and olanzapine improve cognitive function in elderly patients with schizophrenia or schizoaffective disorder. Consistent with research in younger populations, these improvements occur in aspects of cognitive functioning related to functional outcome.     

Brain-derived neurotrophic factor serum and plasma levels in the treatment of acute schizophrenia with olanzapine or risperidone: 6-week prospective study

Antipsychotics have been the mainstay of the treatment of schizophrenia, and their potential role in neuroprotection could be related to brain-derived neurotrophic factor (BDNF). So far different effects on both serum and plasma levels of BDNF were reported related to the various antipsychotic treatments. Aim of this study was to investigate the influence of olanzapine or risperidone on both plasma and serum levels of BDNF in patients with acute schizophrenia. For 50 participants with acute episode of schizophrenia both plasma and serum BDNF, along with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression scale, were assessed pretreatment and post treatment – after 6 weeks of either risperidone or olanzapine. Results show that a weak correlation between pretreatment plasma and serum levels of BNDF was found no longer significant after 6 weeks of treatment. Antipsychotics, olanzapine and risperidone showed no significant effect on post treatment plasma and serum levels of BDNF. Pretreatment plasma level of BDNF and PANSS positive subscale were positively correlated. Post treatment serum level of BDNF and Clinical Global Impression were negatively correlated. In conclusion, plasma and serum BDNF levels could be different markers to some extent with regard to clinical symptoms, response to therapy and outcome. The interrelation between serum and plasma BDNF should be established in further studies.     

Long-term effectiveness of risperidone and olanzapine in resistant or intolerant schizophrenic patients. A mirror study

OBJECTIVE: To evaluate the long-term effectiveness of the second generation antipsychotics, risperidone and olanzapine on hospitalization, clinical response, and adherence to therapy after switching from conventional antipsychotics or clozapine in a naturalistic setting of schizophrenic patients. METHOD: Data were registered for periods of identical duration before and after switching. RESULTS: Fifty-seven patients were included. Mean study period was 3.1 +/- 0.2 years. Mean number of in-patient days after switching declined by 78% of the level before switching (P=0.0002). There was no significant differences in ratio responders/non-responders between the subgroups. The number of patients with extrapyramidal symptoms (EPS) was significantly reduced after switching. However, intolerable weight gain led to a lack of adherence to therapy in 18% of the olanzapine-treated patients. CONCLUSION: Long-term treatment with the second generation antipsychotics, risperidone and olanzapine significantly improved the clinical outcome. However, weight gain may be a significant reason for discontinuation of treatment and reducing the long-term adherence to therapy.     

The impact upon extra-pyramidal side effects,clinical symptoms and quality of life of a switch from conventional to atypical antipsychotics (risperidone or olanzapine) in elderly patients with schizophrenia

BACKGROUND: Atypical antipsychotics are commonly used in the management of schizophrenia in late life with evidence suggesting they induce lower rates of motor disturbance, but have similar efficacy to conventional antipsychotics. Trials in the elderly have been either retrospective, small, of short duration or of a single-arm design. AIMS: To demonstrate the effects upon motor side-effects, efficacy, safety and quality of life (QOL) of switching elderly patients with schizophrenia from conventional antipsychotics to olanzapine or risperidone. METHODS: Elderly patients with schizophrenia were randomly allocated to olanzapine or risperidone and followed through an open-label crossover period. Between and within group intention to treat analyses were conducted. RESULTS: 66 patients were randomised (mean age 69.6 [SD +/- 6.2]). Four (11.8%) patients on olanzapine and 8 (26.7%) patients on risperidone failed to complete the crossover because of treatment failure [Odds Ratio (OR) = 2.73[0.73-10.2] p = 0.14]. The mean doses upon completion of switching in each arm were 9.9 mg (SD = 4.2) and 1.7 mg (SD = 1.2) for olanzapine and risperidone respectively. In both arms there was improvement in Parkinsonism, though only olanzapine was associated with a reduction in dyskinetic symptoms. The Brief Psychiatric Rating Scale, Scale for the assessment of Negative Symptoms and Montgomery and Asberg Depression Rating Scale scores all improved through the crossover period in both arms with no between group differences. Treatment with olanzapine was associated with a better response over risperidone on the psychological domain of the World Health Organisation-Quality Of Life [Brief] (WHO-QOL-BREF) scale ( p = 0.02). Patients in the olanzapine arm also demonstrated improvement from baseline in the WHO-QOL-BREF physical, psychological and health satisfaction domains, but risperidone had no effect on any Quality of Life (QOL) measure. CONCLUSIONS: After switching from a conventional antipsychotic, olanzapine and risperidone were associated with improvement in core symptoms of schizophrenia and motor side effects. Subjects switched to olanzapine were more likely to complete the switching process and show an improvement in psychological QOL.     

High-dose glycine added to olanzapine and risperidone for the treatment of schizophrenia.

BACKGROUND: Clinical trials indicate that glycine site agonists of the N-methyl-D-aspartate (NMDA) receptors may reduce negative and cognitive symptoms in treatment-resistant schizophrenia when used as adjuvants to conventional antipsychotics but possibly not to clozapine. In this study, we assessed whether high-dose glycine may also be therapeutically beneficial when added to olanzapine and risperidone treatment. METHODS: Seventeen olanzapine- or risperidone-treated schizophrenia patients participated in a double-blind, placebo-controlled, 6-week crossover treatment trial with.8 g/kg/day glycine added to their ongoing antipsychotic medication. Clinical assessments were performed biweekly throughout the study. Clinical laboratory parameters and amino acid serum levels were monitored. RESULTS: Glycine treatment was well tolerated and resulted in a significant (p <.0001) 23% +/- 8% reduction in negative symptoms. Significant improvements were also registered in cognitive and positive symptoms. The negative symptoms improvement remained significant even following covariation for changes in other symptom clusters and extrapyramidal side effects. High posttreatment glycine serum levels significantly predicted (r =.60) clinical response. CONCLUSIONS: These findings indicate that the efficacy of olanzapine and risperidone may be augmented using high-dose adjuvant glycine treatment and suggest that these atypical antipsychotics may affect NMDA receptor-mediated neurotransmission differently than clozapine.     

A comparison of the efficacy and safety of olanzapine and risperidone in the treatment of elderly patients with schizophrenia: an open study of six months duration

BACKGROUND: Following an earlier study in which elderly patients with schizophrenia had their typical antipsychotic medication changed to olanzapine or risperidone, the 61 patients were followed for up to a further six months to see if either treatment was superior in terms of efficacy or side effects. AIMS: To determine whether either olanzapine or risperidone was superior in terms of efficacy or side effects when treating schizophrenia in late life. METHODS: Psychiatric symptoms, side effects and quality of life were rated every six weeks for 24 weeks of open label comparative treatment using standard measures. Group differences were examined using analysis of covariance and within-group changes over time were assessed using paired t-tests. RESULTS: There were 34 olanzapine and 32 risperidone patients who entered the study, but intention to treat data was only available for 61 of the 66 patients. There were no clinical or demographic differences between the groups. Parkinsonism, positive and negative symptoms of schizophrenia improved in both groups both from baseline switch to olanzapine or risperidone and during the six month follow-up after completion of crossover. No significant differences were seen between groups on most measures. However, patients treated with olanzapine showed a significantly greater improvement in quality of life from baseline compared to risperidone patients. CONCLUSIONS: Both drugs were well tolerated and their use was associated with fewer symptoms of schizophrenia and less adverse effects than were seen when the patients were taking a typical antipsychotic at baseline. Olanzapine appears to have particular benefit with regard to quality of life.     

奥氮平与利培酮治疗老年期谵妄患者的对照研究

目的:比较奥氮平和利培酮治疗老年期谵妄的疗效和安全性. 方法:将50例老年期谵妄患者随机分成奥氮平治疗组(n=25),利培酮治疗组(n=25),疗程2周.治疗前后以谵妄评定方法中文修订版(CAM-CR)及临床疗效总评量表-病情严重程度(CGI-SI)评定疗效;以治疗中出现的症状量表(TESS)评定药物不良反应. 结...     

Observations on switching patients with schizophrenia to risperidone treatment

This study examined one possible strategy for switching patients to treatment with risperidone involving immediate cessation of current neuroleptics and gradual withdrawal of anticholinergic treatments. All patients received risperidone monotherapy for at least 4 weeks. Side-effects and symptoms were rated and successful switching was defined as completion of the study with no consistent worsening in any rating scales. Of the 41 patients entered, five withdrew for reasons unconnected with the study. Of the remaining 36 patients, 64% (23 patients) were switched successfully. Overall, the rating scales showed significant improvements (mean score on Krawiecka scale, 11.0 to 6.6, P < 0.001), and side-effects decreased (mean score on Simpson & Angus scale, 5.1 to 2.9, P= 0.004). The strategy appeared to be successful for most patients, especially those who had previously received depot medication. However, more gradual withdrawal of previous treatments, including anticholinergics, may be advisable in some cases.     

Long-acting injectable risperidone and oral antipsychotics in patients with schizophrenia: results from a prospective, 1-year,non-interventional study (InORS)

Objective. To explore differences in outcomes for patients with schizophrenia treated with risperidone long-acting treatment (RLAT) or oral antipsychotics (oAP). Methods. The International Observational Registry on Schizophrenia (InORS) explored flexible doses of newly initiated RLAT and oAPs for adults with schizophrenia, exploring 6-month retrospective hospitalization data and 12-month prospective medication use, outcomes, and tolerability. Efficacy outcomes included hospitalizations, the Clinical Global Impression of Schizophrenia (CGI-SCH), and the Global Assessment of Functioning (GAF). Medication switch patterns were also analysed. Results. Data were analysed from 1083 patients (561 RLAT, 522 oAP). At baseline, RLAT patients had higher symptom severity, greater functional impairment, and poorer compliance. Percentages of patients hospitalized were similar between groups, and median duration per hospitalization decreased after RLAT initiation and with oAP. The difference in duration of hospitalization between the retrospective and prospective period was significantly better with RLAT (P = 0.002). Mean CGI-SCH change from baseline was significantly better for RLAT vs. oAP patients for overall, positive, and negative symptom scores (P < 0.05). Mean functional improvement from baseline was significantly higher with RLAT vs. oAP (P < 0.001). Conclusions. Hospitalizations and symptomatic and functional outcomes were better with RLAT vs. oAP; frequent medication switches were associated with less favourable outcomes.     

奥氮平治疗精神分裂症对照研究的Meta分析

目的：探讨奥氮平治疗精神分裂症的疗效和不良反应。方法：应用M eta分析对17篇奥氮平与其他抗精神病药治疗精神分裂症对照研究的文章进行再分析。结果：奥氮平自身对照比较的治疗效应极大（χ^2=141.00,P〈0.05）。治疗2周和治疗结束,奥氮平与对照药疗效比较差异无显著性（P〉0.05）;阳性与阴性症状量表（PANSS）评分比较差异亦无显著性（P〉0.05）。与对照药相比,奥氮平的不良反应显著少于对照药组（P〈0.05或P〈0.01）。结论：奥氮平与对照药的临床疗效相仿,但不良反应明显较少。     

阿立哌唑与利培酮治疗精神分裂症研究

目的：评价阿立哌唑治疗精神分裂症的疗效及不良反应。方法：64例精神分裂症患者,随机分为两组,分别给予阿立哌唑与利培酮治疗8周。采用阳性与阴性症状量表（PANSS）、治疗中出现的症状量表（TESS）评定疗效及不良反应。结果：阿立哌唑组显效率为78.1%,利培酮组为75.0%。利培酮组锥体外系反应稍高于阿立哌唑组。结论：阿立哌唑与利培酮疗效相似,锥体外系反应比利培酮少,是一种有效、安全的抗精神病药物。     

阿立哌唑与利培酮治疗精神分裂症临床研究

目的:评价阿立哌唑治疗精神分裂症的疗效。方法:选择病程≤3年的80例精神分裂症患者,按入院顺序随机分为阿立哌唑组(40例)和利培酮组(40例)进行6周观察。采用阳性与阴性症状量表(PANSS)评定疗效,用副反应量表(TESS)和锥体外系副反应量表(RSESE)评定不良反应。结果:两药治疗精神分裂症疗效相当。阿立哌唑组的锥体外系反应(EPS)发生率32.5%(13例)明显低于利培酮组55.0%(22例)(P<0.05)。结论:阿立哌唑为一种安全有效和耐受性较好的抗精神病药。     

奥氮平与阿立哌唑治疗精神分裂症对照研究

目的:比较奥氮平与阿立哌唑治疗精神分裂症的疗效与安全性。方法:100例精神分裂症患者随机分为两组,每组各50例。分别给予奥氮平和阿立哌唑治疗,疗程8周。采用阳性与阴性症状量表(PANSS)、临床疗效总评量表疾病严重程度(CGI-SI)、治疗中出现的症状量表(TESS)评定疗效及不良反应。结果:两组PANSS总分及CGI-SI评分均较治疗前显著下降(P均<0.01)。奥氮平组显效率76.0%,阿立哌唑组显效率72.0%,两组疗效相仿(P>0.05)。奥氮平组嗜睡、体质量增加、血脂升高的不良反应均明显高于阿立哌唑组(P<0.01);阿立哌唑组锥体外系反应、失眠、兴奋或激越均明显高于奥氮平组(P<0.01)。结论:奥氮平和阿立哌唑对精神分裂症的疗效相当,安全性较高。     

奥氮平与利培酮治疗精神分裂症首次发病患者的疗效

目的:探讨奥氮平与利培酮治疗首发精神分裂症的疗效以及对生活质量的影响。方法:68例首发精神分裂症患者随机分为奥氮平组和利培酮组各34例,分别给予奥氮平和利培酮治疗8周,随访6个月。于治疗前后采用阳性与阴性症状量表(PANSS)及治疗中出现的症状量表(TESS)评定疗效及不良反应;于治疗6个月前后,采用生活质量综合评定问卷(GQOLI)评定生活质量。结果:两组PANSS评分治疗后均有显著下降(P<0.05或P<0.01)。奥氮平组GQOLI总分及各维度与利培酮组GQOLI总分及躯体功能、心理功能维度治疗前后差异均有统计学意义(P均<0.01);两组间比较,治疗前两组GQOLI评分差异无统计学意义,6个月后随访,在躯体功能及社会功能差异有统计学意义(P均<0.01)。结论:奥氮平与利培酮治疗首发精神分裂症疗效相当,但奥氮平在提高生活质量方面略优于利培酮。