奥氮平与利培酮治疗冰毒所致精神障碍的临床对照研究

目的观察奥氮平与利培酮治疗甲基苯丙胺(冰毒)所致精神障碍的疗效和不良反应。方法对我科2011年1月至2012年12月收治的98例符合中国精神疾病分类方案与诊断标准第三版(CCMD-3)诊断为冰毒所致精神障碍的患者,随机分为2组:奥氮平组49例和利培酮组49例,采用阳性与阴性症状量表(PANSS)和不良反应量表(TESS)评定患者的疗效和不良反应。结果奥氮平组有效率为93.8%,利培酮组有效率为89.7%。两组疗效比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异有统计学意义(P<0.05),主要表现在锥体外系不良反应及镇静。结论奥氮平、利培酮均能有效改善冰毒所致的精神病性症状,疗效显著。但奥氮平不良反应发生率低,安全性好。     

喹硫平治疗甲基苯丙胺所致精神障碍的临床观察

目的:观察抗精神病药物喹硫平治疗甲基苯丙胺所致精神障碍的疗效及不良反应,并与利培酮对照。方法:将60例符合《中国精神疾病分类方案与诊断标准》第三版(CCMD-3)诊断的甲基苯丙胺所致精神障碍患者,随机分为两组:喹硫平组和利培酮组,每组各30例。两组分别用喹硫平片(最大剂量≤400mg·d-1)和利培酮(最大剂量≤400mg·d-1)治疗21d。采用《简明精神病评定量表》(BPRS)、《大体功能评定量表》(GAS)和《副反应量表》(TESS)评定患者的精神病症状、疗效和不良反应。结果:喹硫平组总有效率为90.0%,利培酮组为86.7%,两组比较差异无显著性(P>0.05)。与利培酮组比较,喹硫平组对焦虑抑郁、失眠控制较好,锥体外系症状较少,差异有显著性(P<0.05),其他不良反应两组差异无显著性。结论:喹硫平与利培酮疗效相当,但喹硫平对有些症状控制较好,有些不良反应较轻。     

奥氮平治疗50例麻古所致精神障碍患者疗效报道

目的：观察抗精神病药物奥氮平治疗麻古所致精神障碍的疗效及不良反应。方法：将50例麻古所致精神障碍患者予奥氮平治疗28d。使用简明精神病量表（BPRS）进行疗效评定,采用治疗副反应量表（TESS）进行疗后副反应评定。结果：治疗总有效率为88%。不良反应轻微,主要为体重增加、嗜睡、头昏及口干便秘。结论：奥氮平治疗麻古所致精神障碍疗效肯定,不良反应少,安全可靠。     

利培酮治疗冰毒所致精神障碍40例疗效观察

目的:观察利培酮治疗甲基苯丙胺(冰毒)所致精神障碍的疗效和不良反应。方法:对80例符合中国精神疾病分类方案与诊断标准第三版(CCMD-3)诊断为冰毒所致精神障碍的患者,随机分为两组:利培酮组40例和安慰剂组40例。采用简明精神病量表、临床疗效总评量表和副反应量表评定患者的精神病性症状、疗效和不良反应。结果:利培酮组有效率为89.9%,安慰剂组为33.6%。两组间差异非常显著(P<0.01)。两组副反应发生率差异无显著性(P>0.05)。结论:利培酮能有效改善冰毒所致的精神病性症状,疗效显著,无明显不良反应发生,安全性好。     

利培酮口服液与奥氮平治疗酒精所致精神障碍对照研究

目的:探讨利培酮口服液与奥氮平治疗酒精所致精神障碍的疗效和安全性。方法:将68例男性酒精所致精神障碍患者随机分为利培酮口服液治疗组和奥氮平治疗组。采用阳性与阴性症状量表(PANSS)评定临床疗效;采用治疗副反应量表(TESS)评定药物不良反应。结果:利培酮口服液与奥氮平两组疗效差异无显著性。利培酮口服液主要不良反应为锥外系反应,奥氮平为体重增加。结论:利培酮口服液与奥氮平治疗酒精所致精神障碍疗效及耐受性均好,可根据用药对象对不良反应的耐受等情况进行选择。     

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。     

奥氮平治疗艾滋病合并精神障碍临床疗效观察

目的探讨奥氮平治疗艾滋病合并精神障碍的临床疗效。方法选取2011年12月～2013年12月来我院接受治疗的艾滋病合并精神障碍患者54例,这些患者均符合精神障碍诊断标准。将这些患者随机分为以下两组,即治疗组与对照组。治疗组的患者给予奥氮平治疗,而对照组患者则给予利培酮治疗,通过为期8周的治疗过程后,应用精神病评定量表评分来观察这些患者的临床疗效,并且观察这些患者所产生的不良反应发生率。结果治疗组患者BPRS精神病评定量表的评分为（43．5±5．38）分,明显低于对照组患者的BPRS精神病评定量表的评分结果（48．96±6．18）分,治疗组的治疗方法优于对照组患者的治疗方法,两组之间具有显著性差异,P〈0．05。结论奥氮平药物应用于艾滋病合并精神障碍患者治疗中,能够有效改善患者的精神病状况,在临床治疗中具有较积极的意义。     

无抽搐电休克(MECT)治疗合成毒品所致的精神障碍的疗效及不良反应的回顾性分析

目的:探讨分析无抽搐电休克(MECT)治疗合成毒品所致的精神障碍的疗效及不良反应。方法:回顾性分析2015年3月-2016年6月期间在广州某医院住院且接受无抽搐电休克(MECT)治疗的41例合成毒品所致的精神障碍患者的病历资料,所有患者符合ICD-10精神活性物质所致的精神和行为障碍:精神病性障碍的诊断标准。结果:各类合成毒品所致的精神和行为障碍接受MECT治疗的痊愈率为43.9%,显效率为53.7%,有效率为2.4%;甲基苯丙胺组、氯胺酮组、多种药物滥用组均有效。MECT治疗后未发生严重不良反应。结论:无抽搐电休克治疗疗效肯定,不良反应少,安全性好,值得在合成毒品所致的精神障碍中应用推广。     

奥氮平与齐拉西酮治疗脑器质性精神障碍的对照研究

目的比较奥氮平(再普乐)与齐拉西酮(力复君安)治疗脑器质性精神障碍的临床疗效和安全性。方法将60例脑器质性精神障碍患者随机分成奥氮平(再普乐)组和齐拉西酮(力复君安)组,疗程为4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。结果奥氮平(奥氮平)与齐拉西酮(力复君安)的疗效差异无显著性。奥氮平的主要不良反应是嗜睡、体重增加,齐拉西酮的主要不良反应是锥体外系反应、失眠。结论奥氮平与齐拉西酮均是治疗脑器质性精神障碍安全有效的非典型抗精神病药物,可根据患者的不同个体需要分别选择。     

喹硫平与奥氮平治疗酒精所致精神障碍的对照研究

目的比较喹硫平与奥氮平在治疗酒精所致精神障碍的疗效以及临床应用价值。方法 2009年1月至2011年6月,我院精神科收治的酒精所致精神障碍患者86例,随机分为喹硫平组和奥氮平组,各43例。86例患者给予相同的支持治疗的基础上,喹硫平组给予4周的喹硫平治疗,奥氮平组给予4周的奥氮平治疗,治疗前后采用简明精神病评定量表(BPRS)进行疗效评定,副反应量表(TESS)进行不良反应判断,并进行统计学检验。结果喹硫平组痊愈23例、显效17例、有效3例、无效0例,总有效率为100.0%;奥氮平组痊愈25例、显效16例、有效2例、无效0例,总有效率为100.0%;两组有效率无明显差异。两组治疗前后BPRS评分均无统计学差异,治疗后评分均低于治疗前,差异有统计学意义(P<0.05)。结论喹硫平与奥氮平均能有效的治疗酒精所致精神障碍,疗效显著、不良反应较少、患者依从性较好,能显著改善病情,值得临床应用和推广。     

奥氮平治疗精神分裂症血药浓度、剂量与临床疗效、不良反应的相关性分析

目的观察奥氮平治疗精神分裂症的剂量、血药浓度与临床疗效、药物副反应的关系。方法对男女各30例精神分裂症患者用简明精神病评定量表（BPRS）、临床总体印象量表（CGI）、副反应量表（TESS）评定疗效和副反应;用反相高效液相色谱法测定病人第四、八周末的奥氮平血药浓度。结果（1）奥氮平血药浓度与剂量成正相关,未发现奥氮平血药浓度与患者年龄、性别和病程有明显关系;（2）奥氮平的治疗效果从第二周开始与治疗前有显著性差异,副反应主要表现为体重增加,从第二周开始即与治疗前有显著性差异,且没两周后的体重均较前有显著性差异;（3）奥氮平的血药浓度及剂量与患者的临床疗效及副反应在第四、八周均显示有相关性。结论奥氮平能有效治疗精神分裂症．副反应主要表现为体重增加;奥氮平的血药浓度及剂量与患者的临床疗效及副反应有相关性。     

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。     

Comparing tolerability of olanzapine in schizophrenia and affective disorders: a meta-analysis

Background: Olanzapine is prescribed for a number of psychiatric disorders, including schizophrenia, bipolar mania, and unipolar and bipolar depression. Olanzapine treatment is associated with tolerability issues such as metabolic adverse effects (e.g. weight gain, increase in blood glucose, triglycerides and total cholesterol levels), extrapyramidal symptoms [EPS] (e.g. parkinsonism, akathisia, tardive dyskinesia) and sedative adverse effects. Metabolic issues lead to some long-term consequences, which include cardiovascular diseases (CVD) and type 2 diabetes mellitus, and these complications cause high rates of mortality and morbidity among patients with severe mental illnesses. The expanded indications of olanzapine in psychiatry suggest a need to investigate whether there is a difference in the incidence and severity of adverse effects related to category diagnosis. Are the adverse effects expressed differently according to phenotype? Unfortunately, there are no reported studies that investigated these differences in adverse effects associated with olanzapine treatment in psychiatric patients with different phenotypes. Objective: The aim of the present meta-analysis is to separately examine olanzapine-induced cardiometabolic adverse effects and EPS in patients with schizophrenia and affective disorders. Data Sources: A search of computerized literature databases PsycINFO (1967-2010), PubMed (MEDLINE), EMBASE (1980-2010) and the clinicaltrials.gov website for randomized clinical trials was conducted. A manual search of reference lists of published review articles was carried out to gather further data. Study Selection: Randomized controlled trials were included in our study if (i) they assessed olanzapine adverse effects (metabolic or extrapyramidal) in adult patients with schizophrenia or affective disorders; and (ii) they administered oral olanzapine as monotherapy during study. Data Extraction: Two reviewers independently screened abstracts for choosing articles and one reviewer extracted relevant data on the basis of predetermined exclusion and inclusion criteria. It should be mentioned that for the affective disorders group we could only find articles related to bipolar disorder. Data Synthesis: Thirty-three studies (4831 patients) that address olanzapine monotherapy treatment of adults with schizophrenia or bipolar disorder were included in the analysis. The primary outcomes were metabolic adverse effects (changes in weight, blood glucose, low-density lipoprotein, total cholesterol and triglyceride levels). The secondary outcomes of our study were assessing the incidence of some EPS (parkinsonism, akathisia and use of antiparkinson medication). The tolerability outcomes were calculated separately for the schizophrenia and bipolar disorder groups and were combined in a meta-analysis. Tolerability outcomes show that olanzapine contributes to weight gain and elevates blood triglycerides, glucose and total cholesterol levels in both schizophrenia and bipolar disorder patients. However, olanzapine treatment produced significantly more weight gain in schizophrenia patients than in bipolar disorder patients. In addition, increases in blood glucose, total cholesterol and triglyceride levels were higher in the schizophrenia group compared with the bipolar disorder group, even though these differences were not statistically significant. Based on our results, the incidence of parkinsonism was significantly higher in the schizophrenia group than in the bipolar disorder group. Subgroup analysis and logistic regression were used to assess the influence of treatment duration, dose, industry sponsorship, age and sex ratio on tolerability outcome. Conclusions: Our results suggest that schizophrenia patients may be more vulnerable to olanzapine-induced weight gain. The findings may be explained by considering the fact that in addition to genetic disposition for metabolic syndrome in schizophrenia patients, they have an especially high incidence of lifestyle risk factors for CVD, such as poor diet, lack of exercise, stress and smoking. It might be that an antipsychotic induces severity of adverse effect according to the phenotype.     

Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study

The second generation antipsychotics clozapine and olanzapine frequently induce weight gain. Randomized studies investigating abnormal eating behavior (food craving, binge eating) possibly associated with weight gain are lacking. Thirty patients with schizophrenia, schizophreniform, or schizoaffective disorder were included in this randomized, double-blind, parallel study comparing abnormal eating behavior using a standardized scale, clinical efficacy using the Brief Psychiatric Rating Scale 0-6 and Clinical Global Impression-Severity scale, and tolerability of clozapine and olanzapine. In both treatment groups, the number of patients reporting food craving, binge eating, or both increased over time. The likelihood to experience food craving at any time during drug treatment showed a trend (P = 0.068) to be higher in the olanzapine group (48.9%) compared with the clozapine group (23.3%). The likelihood to experience binge eating at any time during drug treatment was numerically but not statistically significantly higher in the olanzapine group (16.7%) than in the clozapine group (8.9%). In both groups, significant baseline-to-end point improvements of clinical symptoms (Brief Psychiatric Rating Scale 0-6: clozapine, 36.6 +/- 8.8 to 15.9 +/- 13.7; olanzapine, 36.7 +/- 9.9 to 19.1 +/- 13.8) and severity of illness (Clinical Global Impression-Severity scale: clozapine, 4.7 +/- 0.6 to 2.5 +/- 1.5; olanzapine, 4.5 +/- 0.6 to 2.3 +/- 1.2) were observed. These improvements did not differ significantly between groups. Olanzapine was more tolerable than clozapine; adverse events occurred significantly (P < 0.01) less frequently than in the clozapine group. These results suggest that both clozapine and olanzapine can induce food craving and binge eating, however, olanzapine possibly to a greater extent. Findings on clinical efficacy and safety are in accordance with previous reports.     

Aripiprazole as a viable alternative for treating delusions of parasitosis

Delusions of parasitosis (DOP) is a psychiatric disorder characterized by the fixed false belief that one is infested with parasites or other organisms. Historically, pimozide, a first-generation antipsychotic, has been the treatment of choice for DOP, although there is risk for serious adverse effects including extrapyramidal symptoms, QTc prolongation and tardive dyskinesia. Recently, there have been several reports describing the effectiveness of second-generation antipsychotics (SGAs), but these agents have their own unique adverse effects, specifically metabolic changes with olanzapine, sedation with quetiapine and hyperprolactinemia with risperidone. Aripiprazole is a novel, third-generation antipsychotic with comparable efficacy to SGAs, but a more favorable side effect profile. Successful treatment of DOP with aripiprazole has recently been described in the psychiatric and dermatologic literature. The authors present another report to support the use of aripiprazole as an efficacious and safe alternative for treating DOP.     

帕罗西汀与阿米替林治疗躯体化障碍的疗效比较

目的比较帕罗西汀与阿米替林治疗躯体化障碍的疗效和不良反应。方法81例躯体化障碍患者随机分成2组,分别用帕罗西汀与阿米替林治疗8 wk。用症状自评量表(SCL-90)中的躯体化、抑郁和焦虑3个因子总分评定症状变化,用不同减分率评定疗效。用不良反应量表(TESS)评定药物不良反应。结果帕罗西汀组痊愈率为61.90%,总有效率为90.48%;阿米替林的痊愈率为43.59%,总有效率为71.79%,2组疗效比较差异有统计学意义(P<0.05)。2组TESS测评,各时点组间比较,差异有统计学或高度统计学意义(P<0.05或P<0.01)。结论帕罗西汀治疗躯体化障碍疗效确切,不良反应较小。     

Atypical antipsychotics for nursing home patients: a retrospective chart review

BACKGROUND AND OBJECTIVE: To compare the efficacy and safety of risperidone and olanzapine in the treatment of psychotic symptoms and behavioural disturbances in institutionalised patients with dementia and other psychiatric disorders. METHODS: We conducted a retrospective chart review of nursing home patients with psychiatric disorders or dementia in 65 long-term care facilities in New Jersey and Pennsylvania who had received treatment with risperidone or olanzapine. We determined the efficacy of the two antipsychotics for the treatment of psychotic symptoms or behavioural disorders in patients with dementia, the incidence of falls in ambulatory patients, and the incidence of adverse events in the total sample of patients. RESULTS: A total of 289 long-term care patients were included in the analysis. Diagnoses included dementia in 59%, schizophrenia in 20%, bipolar disorder in 8%, schizoaffective disorder in 6% and other diagnoses in 10%. The mean ages were 77 years in patients receiving risperidone and 81 years in patients receiving olanzapine. Risperidone was received by 141 patients and olanzapine by 148 patients. In the 171 patients with dementia, significantly greater improvements in psychotic symptoms and behavioural disturbances were seen in patients receiving risperidone compared with those receiving olanzapine (p < 0.05). In the 222 ambulatory patients, > or = 1 fall was recorded in 19% of patients receiving risperidone and in 38% of patients receiving olanzapine (p = 0.001). The fall rate per month was 0.06 in risperidone recipients and 0.17 in olanzapine recipients (p < 0.001). Adverse events were reported in 6% (9/141) of risperidone-treated patients compared with 34% (42/110) of olanzapine-treated patients (p < 0.001). Adverse events seen only in the olanzapine group were constipation, dry mouth, dysphasia, sedation and dizziness. CONCLUSION: The results of this review indicate that risperidone was more efficacious and better tolerated than olanzapine in the treatment of nursing home patients with psychotic symptoms and behavioural disturbances.