非典型抗精神病药物对老年患者心脏功能的影响

目的 探讨非典型抗精神病药物对老年精神病患者心脏功能的影响.方法 对入院的33例老年精神病患者在治疗前、治疗第4,8周分别进行血清肌钙蛋白（cTn）、肌红蛋白（MB）、B型钠尿肽（BNP）、心肌酶谱（CK、CKMB、LDH、AST）及心率校正QT间期（QTc）检测,并比较治疗前后各指标变化.结果 QTc治疗前后均正常范围.LDH异常率由治疗前36.36％下降到治疗后15.15％,差异接近统计学水准（P=0.057）.其他各指标在治疗前后虽存在部分异常,但差异并无统计学意义（P＞0.05）.治疗前LDH显著高于治疗后第4,8周,差异有统计学意义（P＜0.05）,而第4,8周间LDH比较差异无统计学意义（P＞0.05）; cTn、MB、BNP、CK、CKMB、AST在治疗前后差异无统计学意义（P＞0.05）.QTc在治疗第4,8周较治疗前显著延长,差异有统计学意义（P＜0.01）,而第4周、第8周QTc比较差异无统计学意义（P＞0.05）.结论 非典型抗精神病药物在治疗初期通过控制兴奋症状有助于改善老年精神病患者部分心脏功能指标,但对QTc有延长作用.因此,临床实践中需注意心脏相关指标的监测,尤其在治疗初期.     

非典型抗精神病药物对患者体质量的影响

非典型抗精神病药物对代谢的影响包括体质量增加、血糖升高、血脂代谢异常、催乳素水平升高等。目前对瘦素的研究于进一步揭示非典型抗精神病药物对体质量增加的作用机制具有意义。     

非典型抗精神病药治疗情感障碍

本文对非典型抗精神病药氯氮平、维思通、奥氮平、奎的平的抗躁狂和抗抑郁作用作一综述。     

非典型抗精神病药治疗情感障碍

本文对非典型抗精神病药氯氮平，维思通，奥氮平，奎的平的抗躁狂和抗抑郁作用作一综述。     

非典型抗精神病药物在双相抑郁治疗中的应用

本文综述了非典型抗精神病药物在双相抑郁治疗中应用的最近研究进展情况     

非典型抗精神病药物致肝损害研究进展

非典型抗精神病药物是目前治疗精神分裂症的一线用药,随着其在临床日益广泛的应用,药物性肝损害（drug-induced liver injury,DILI）的发生率逐年上升,甚至在个别药物治疗中出现了严重药物性肝损害的病例报道。本文将对非典型抗精神病药物性肝损害的诊断、发生机制、常用非典型抗精神病药物对肝功能的影响、治疗与预防的研究进展作简要综述。     

非典型抗精神病药对心血管和代谢的影响

本文就非典型抗精神病药物对心血管及代谢系统的影响作一概念。     

非典型抗精神病药治疗情感障碍的应用

非典型抗精神病药有独特的作用机制,且作用谱广,常用来治疗情感障碍.本文对氯氮平、奥氮平、维思通及奎硫平等非典型抗精神病药治疗情感障碍的国外部份近期有关文献内容作如下综述.     

碳酸锂合并典型和非典型抗精神病药治疗双相障碍躁狂发作的1年随访

目的探讨碳酸锂合并典型和非典型抗精神病药物治疗双相障碍躁狂发作患者1年的疗效及安全性。方法将94例双相障碍躁狂发作患者分为两组,分别给予碳酸锂合并典型抗精神病药物(典型组,43例)和非典型抗精神病药物(非典型组,51例)治疗,随访1年。采用Bech-Rafaelsen躁狂量表(BRMS)、临床大体印象量表(CGI)、副反应量表(TESS)以及药物依从性量表分别于入组前和入组第1、2、4、8、12个月末进行评定,比较两组的疗效及安全性。结果治疗结束时,两组BRMS评分较入组时均显著减低(P<0.01);典型组和非典型组的临床总有效率分别为95.3%和96.1%,差异无统计学意义(P>0.05)。两组的不良反应发生率差异无统计学意义(P>0.05)。非典型组在12个月末依从性优于典型组(P<0.05)。结论碳酸锂合并典型和非典型抗精神病药物治疗双相障碍躁狂发作的疗效相当,但后者依从性更好     

Metabolic consequences of atypical antipsychotic drugs

Atypical antipsychotic drugs have become the treatment of choice for psychotic disorders. However, these medications, though certainly superior in many respects to the more traditional medications, have been shown to have a number of untoward consequences. Understanding of the metabolic consequences of these medications is essential for the psychiatrist. The possible development of diabetes, weight gain, and hypertriglyceridemia in patients taking atypical antipsychotics makes it imperative that the prescribing physician regularly monitor patients on these agents. One possible monitoring scheme is outlined and recommendations for treatment are discussed.     

Serotonin and dopamine antagonism in obsessive-compulsive disorder: effect of atypical antipsychotic drugs

BACKGROUND: Previous reports suggest that some atypical antipsychotics may have obsessogenic as well as antiobsessional effects. Given their higher affinity for serotonin 5HT2 receptors than dopamine D2 receptors, it has been speculated that atypical antipsychotics may induce obsessive-compulsive (OC) symptoms, even at low doses, due to high 5HT2 antagonism, whereas improvement in OC symptoms is thought to occur only at high doses due to high D2 antagonism. METHOD: In this open case series, the dose-response relationship of atypical antipsychotic augmentation in the treatment of obsessive compulsive disorder (OCD), and the dose-severity relationship in atypical anti psychotic-induced OC symptoms were examined. Three patients were identified who had either refractory OCD or OC symptoms following administration of atypical antipsychotics such as olanzapine and risperidone. RESULTS: Case 1: A linear dose-response relationship between increasing doses of olanzapine and improvement in OC symptoms was observed in an OCD patient resistant to 5-HT reuptake inhibitors. 2: OC symptoms induced by low doses of risperidone (1 mg) were reversed by increasing the doses of risperidone (3 mg) in a bipolar disorder patient suggesting an inverse dose-severity relationship. 3: No inverse dose-severity relationship was noted between olanzapine induced OC symptoms and its dosage in an asymptomatic OCD patient. Tretment-emergence OC symptoms responded to increasing the doses of maintanance clomipramine treatment. CONCLUSIONS: Controlled studies are needed to investigate the dose-response or dose-severity relationships between OCD and atypical antipsychotics.     

Tardive dyskinesia and atypical antipsychotic drugs

Typical antipsychotic agents produce central nervous system effects, especially extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). Nearly every patient who receives neuroleptic therapy has one or more identifiable risk factors for TD, among the most significant of which are older age, female gender, presence of EPS, diabetes mellitus, affective disorders, and certain parameters of neuroleptic exposure (i.e. dose and duration of therapy). The typical course of TD is a gradual onset after several years of drug therapy, followed by slow improvement or remission, but a large number of patients have persistent TD with irreversible symptoms. In the management of TD, the patient's mental status is of primary concern. Currently, no uniformly safe and effective therapies for TD exist, though a variety of therapeutic agents, including some of the atypical neuroleptics, have been reported to treat TD successfully in some patients. Because TD liability is so much lower with novel antipsychotic therapy, all patients who have TD or are at risk for TD, as well as EPS, should be considered candidates for switching to these new drugs.     

Neuroleptic malignant syndrome and atypical antipsychotic drugs

OBJECTIVE: The incidence of neuroleptic malignant syndrome (NMS) is not known, but the frequency of its occurrence with conventional antipsychotic agents has been reported to vary from 0.02% to 2.44%. DATA SOURCES: MEDLINE search conducted in January 2003 and review of references within the retrieved articles. DATA SYNTHESIS: Our MEDLINE research yielded 68 cases (21 females and 47 males) of NMS associated with atypical antipsychotic drugs (clozapine, N = 21; risperidone, N = 23; olanzapine, N = 19; and quetiapine, N = 5). The fact that 21 cases of NMS with clozapine were found indicates that low occurrence of extrapyramidal symptoms (EPS) and low EPS-inducing potential do not prevent the occurrence of NMS and D(2) dopamine receptor blocking potential does not have direct correlation with the occurrence of NMS. One of the cardinal features of NMS is an increasing manifestation of EPS, and the conventional antipsychotic drugs are known to produce EPS in 95% or more of NMS cases. With atypical antipsychotic drugs, the incidence of EPS during NMS is of a similar magnitude. CONCLUSIONS: For NMS associated with atypical antipsychotic drugs, the mortality rate was lower than that with conventional antipsychotic drugs. However, the mortality rate may simply be a reflection of physicians' awareness and ensuing early treatment.     

Movement disorders associated with atypical antipsychotic drugs

Data from clinical trials reviewed in this article fulfill predictions based on preclinical findings that atypical antipsychotic drugs are associated with a reduced potential for inducing extrapyramidal symptoms (EPS) and other movement disorders. Atypical drugs have been shown to reduce all subtypes of acute EPS, the frequency of EPS-related patient dropouts, and the need for concomitant antiparkinsonian drug use. Clozapine remains superior to other atypicals in treating psychosis without worsening motor symptoms in patients with Parkinson's disease. Atypicals may be selectively advantageous in treating schizophrenic patients with a predisposition to catatonia. Although the risk of developing lethal neuroleptic malignant syndrome may be diminished with atypical drugs, clinicians must remain alert to the signs of this disorder. Atypicals have reduced liability for inducing tardive dyskinesia (TD) and show antidyskinetic properties in patients with preexisting TD. Passive resolution of TD may be facilitated in some patients by the use of these agents. Thus, the risk of movement disorders has become only one of several considerations in choosing among antipsychotic drugs.     

非经典抗精神病药物与代谢综合征的相关性

国内外近年对非经典抗精神病药与代谢综合征的关系,特别是某些非经典抗精神病药与体重增加的关系,以及个别非经典药物与糖尿病的关系等讨论较多.本文旨在通过回顾以往10年中的相关研究,总结现有研究数据可以推衍的结论,解读这些结论的临床意义;同时也讨论目前研究及其局限性,以及这些局限对临床实践和今后研究的意义.     

抗精神病药物对脑电图的影响

分析传统和新型抗精神病药物的作用机制,探讨不同抗精神病药物对脑电图的影响,从而指导临床合理用药。传统和新型抗精神病药物对脑电图的影响不同,氯氮平和奥氮平对脑电图影响较大,利培酮和典型抗精神病药物次之,喹硫平相对较低,大多与剂量呈正相关,且早期脑电图的改变对抗精神病药物的疗效有一定的预测作用。     

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being.The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.     

抗精神病药对血清细胞因子的影响

目的：探讨抗精神病药对精神分裂症患者血清细胞因子的影响。方法：对４６例精神分裂症患者给予抗精神病药治疗６周,在治疗前后检测血清ＩＬ－６和ＴＮＦ－α水平,并采用阳性与阴性症状量表（ＰＡＮＳＳ）、副反应量表（ＴＥＳＳ）评估临床症状变化及药物副反应。结果：抗精神病药治疗后,血清ＩＬ－６水平显著下降,血清ＴＮＦ－α水平变化不显著。治疗前血清ＩＬ－６水平与ＰＡＮＳＳ阳性因子分显血清ＩＬ－６水平显著下降,血清