奥氮平合并碳酸锂治疗女性急性躁狂发作的疗效及依从性

目的探讨使用奥氮平、利培酮、氯氮平3种非典型抗精神病药分别合并碳酸锂治疗女性躁狂发作疗效和院外服药依从性。方法按照随机的原则将84例女性患者分为3组,分别使用奥氮平、氯氮平、利培酮合并碳酸锂治疗,在急性期不少于4周的住院期间使用Bech—Rafaelsen躁狂量表（BRMS）、临床总体印象量表（CGI）评估疗效;院外治疗期8周内,应用在Morisky问卷基础上改进的自编依从性问卷对患者及其家属进行调查。结果住院期间奥氮平组起效时间中位数为3d,明显早于利培酮组的（7d）（Z=4．75,P〈0．01）;奥氮平组与氯氮平组（3d）的起效时间差异无统计学意义;治疗2周、4周后奥氮平组BMRS减分值与氯氮平组相当（Z=0．54、0．67,P=0．40、0．49）,而大于利培酮组（Z=3．04、1．98,P〈0．01、P=0．04）。随访期间奥氮平组服药依从性评分高于其他两组。结论奥氮平应用于女性急性躁狂发作患者起效迅速,维持治疗时服药依从性良好,其常见不良反应为过度镇静、头晕和体质量增加。     

氯氮平治疗的性别差异

氯氮平治疗的性别差异傅鹃对１９９３～１９９４年期间住院，以氯氮平单项治疗的精神分裂症患者进行观察，男女各５０例，诊断均符合ＣＣＭＤ—２标准。男性平均年龄２９．７±９．８岁，平均病期２．７±２．１年，平均住院２．３±１．０次。女性平均年龄２６．８±７．...     

利培酮与氯氮平维持治疗精神分裂症三年随访对照研究

目的比较利培酮与氯氛平治疗精神分裂症的长期效果。方法对经利培酮与氯氮平治疗出院的精神分裂症患者各58例进行3年随访,以总体印象量表（CGI）、副反应量表（TESS）及社会功能缺陷量表（SDSS）评估两种药物长期维持治疗时的临床疗效、药物副反应及社会功能康复状况。结果CGI中的疗效指数EI：利培酮组高于氯氮平组,两者存在显著差异（P〈0．05）;TESS评分：利培酮组与氯氮平两者无显著差异;SDSS评分：利培酮组与氯氮平组存在显著差异（P〈0．001）。同时,利培酮与氯氮平治疗患者3年内复发率为25．9％和39．6％,再住院率分别为10．6％和53．1％,x2=8．3,P〈0．01,两者间具有显著性差异。结论利培酮比氯氮平更适合精神分裂症患者的长期维持治疗．     

利培酮治疗儿童精神分裂症临床对照研究

有报道氯氮平治疗儿童精神分裂症疗效确定 [1 ] ,我们以氯氮平为对照观察利培酮对儿童精神分裂症的疗效与副反应 ,报告如下。1　对象与方法于 1997年 4月～ 2 0 0 0年 10月在我院住院 ,发病年龄小于 14岁的患者 ,符合 CCMD- 2 - R精神分裂症诊断标准 ,年龄 12～ 18岁 ,病程 3个月～ 5年 ,入院时简明精神病评定量表 ( BPRS)≥ 4 0分。共 4 0例 ,将病人随机平分为 2组 ;利培酮组及氯氮平组各 2 0例。两组平均年龄与病程差异均无显著性 ( P均 >0 .0 5 )。入组时停药清洗 1周。利培酮剂量最大 5 mg/d,氯氮平4 5 0 mg/d。疗程 8周。治疗中可…     

利培酮和氯氮平治疗精神分裂症病人的住院行为对照研究

目的：比较氯氮平和利培酮治疗的精神分裂症病人的住院行为及病房管理情况。方法：94例精神分裂病人随机分成二组,分别给予氯氮平与利培酮治疗8周,用PANSS,TESS,精神康复活动量表（SPRAI）分别评价疗效,不良反应和精神康复精神,同时医护人员对病人在病房的管理难易情况进行评分。结果：遵守制度,安心合作,兴趣程度和操作表现四个因子方面差异有显著性,医生护士认为用利培酮治疗的病人不如用氯氮平治疗的病人“好”,用护士评分比医生差;但二组病人疗效相当,利培酮副反应较轻,SPRAI总分二级差异无显著性。结论：医生护士认为利培酮治疗的病人“不好”,病房管理较困难,但精神病症状控制良好,社会康复程度高,亟需改变封闭病房传统管理模式。     

单独用利培酮及其联合氯氮平治疗精神分裂症的疗效观察

作者对单独用利培酮及其联合用氯氮平治疗精神分裂症的疗效进行了观察，现将结果报告于后。１对象与方法１．１对象①符合ＣＣＭＤ－２－Ｒ精神分裂症诊断标准；②ＢＰＲＳ＞３５分；③排除心、肝、肾等严重躯体疾病；本文共计４０例。其中，利培酮联用氯氮平组２０例（男１３例，女７例），年龄２２～５０岁，平均（３３．３７±６．３１）岁，平均病程（３．３９±３．４２）年；单独用利培酮组２０例（男１４例，女６例），年龄１５～５３岁，平均（３１．２８±１１．１２）岁，平均病程（３．１４±２．７９）年。两组间无显著性差异（…     

利培酮替换氯氮平治疗精神分裂症临床研究

目的：探索以利培酮替换氯氮平的临床换药方法。方法：受试患者随机进入3组;单用利培酮组,利培酮＋安坦组,利培酮＋阿普唑仑组,在治疗前、治疗后1、2、4、6周用阳性症状与阴性症状量表达（PANSS)、体外系副反应量表（ESRS）、不良反应症状量表（TESS）比较其疗效和副反应。结果：3组换药后疗效均显著（P＜0．01）,3组间无显著差异（P＞0．05）。女性较男性副反应大一些,利培酮＋阿普唑仑组副反应最轻,单用利培酮组副反应最大,结论：利培酮＋阿普唑仑替换氯氮平方案较佳。     

利培酮对精神分裂症病人的认知功能影响及其护理相关性分析

认知功能障碍是精神分裂症的核心特征［１］，也是影响精神病临床护理工作的一个重要环节。为此，本文从护理角度出发以氯氮平作为对照组，观察利培酮对精神分裂症病人的认知和行为的影响，旨在为临床护理工作提供参考。１资料与方法１．１对象系１９９７年１０月～１９９８年３月在我院首次住院的４０例病人，其诊断符合ＣＣＭＤ－２－Ｒ中精神分裂症的诊断标准。年龄１８～５９岁之间。病程１～３年。随机分为利培酮和氯氮平组，每组男∶女＝３∶１。利培酮组平均年龄为（３６．５±７．９）岁，氯氮平组为（３７．５±８．９）岁。两组在…     

氯氮平合并利培酮与氯氮平合并舒必利治疗难治性精神分裂症的对照研究

目的：研究对比氯氮平合并利培酮与氯氮平合并舒必利治疗难治性精神分裂症的疗效和安全性。方法：把住院的60例难治性精神分裂症患者，随机分为A，B两组，A组应用氯 平合并利培酮治疗，B组应用氯氮平合并舒必利治疗，观察8周，分别在治疗前与治疗后用阳性与阴性症状量表（PANSS）和不良反应症状量表（TESS）评定。结果：A组治疗8周后总有效率为70％，B组治疗8周后总有效率为63．3％，两组间疗效无显著差异（P＞0．05），TESS总分两组间有显著差异（P＜0．05），B组副反应大。结论：对难治性精神分裂症病人，氯氮平合并利培酮与氯氮平合并舒必利治疗均取得了较好的效果，A组副反应轻。     

利培酮与氯氮平辅助治疗老年躁狂症研究

目的：观察利培酮与氯氮平分别合并碳酸锂治疗老年躁狂症的疗效和不良反应。方法：将62例老年躁狂症随机分为两组,在服用碳酸锂的基础上分别合并利培酮或氯氮平治疗。疗程6周,采用躁狂量表（BRMS）评定疗效,采用治疗中出现的症状量表（TESS）评定不良反应。结果：利培酮与氯氮平疗效相当,利培酮起效时间迟于氯氮平,但不良反应较轻,依从性好。结论：利培酮合并碳酸锂与氯氮平合并碳酸锂治疗躁狂症总体疗效相当,但安全性较高。     

维思通与氯氮平治疗精神分裂症对照分析

用维思通治疗精神分裂症３３例，与用氯氮平治疗的３１例进行对照研究。两组以阴性症状量表（ＳＡＮＳ），阳性症状量表（ＳＡＰＳ），简明精神病量表（ＢＰＲＳ）和副反应量表进行盲式评分。结果显示：虽然氯氮平对治疗阴性阳性症状均有较好疗效，但维思通更明显优于氯氮平，且副作用较小。本文对维思通的疗效，临床应用，副作用，作用机理进行了讨论。     

利培酮与氯氮平治疗首发精神分裂症对认知功能的影响

目的 比较利培酮和氯氮平对首发精神分裂症患者认知功能的影响。方法 将符合入组标准的首发精神分裂症患者77例随机分为利培酮组与氯氮平组,分别进行8周系统治疗,用阳性与阴性症状量表(PANSS)、韦氏成人智力量表(WAIS-RC)、数字划销试验(CT)和临床记忆量表(CMS)进行检查,评估其疗效和对认知功能的影响。结果 脱落4例,73例患者在8周治疗后PANSS总分明显下降(P<0.01),两组之间差异无显著性(P>0.05)。利培酮组的WAIS-RC、CT、CMS总分均明显高于氯氮平组,差异有显著性(P<0.05～0.01)。结论 利培酮对首发精神分裂症患者认知功能的影响明显好于氯氮平。     

利培酮与氯氮平治疗精神分裂症对照研究

目的 评价利培酮治疗精神分裂症的疗效和副作用。方法 将５９例精神分裂症住院病人随机分配到利培酮１组,利培酮２组和氯氮平组（２０例）,治疗８周。用阳性与阴性症状量表（ＰＡＮＳＳ）评定疗效,用副反应量表及锥体外系副反应量表评定副反应。结果 利培酮两个剂量组与氯氮平组之间疗效无显著性差异。在认知因子,阴性因子,ＰＡＮＳＳ总分减分率方面,利培酮组与氯氮平组有显著性差异,利培酮的副反应有锥体外系反应、失眠、     

氯氮平和利培酮治疗精神分裂症患者比较研究

目的 评价氯氮平和利培酮治疗精神分裂症的疗效和副作用。方法 将40例精神分裂症患者随机分为氯氮平组和利培酮组(氯氮平组20例,利培酮组20例),于治疗前和治疗12周末各作一次韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验、言语流利性测验、连线测验A、简明精神症状评定量表(BPRS)、TESS副反应量表。结果 治疗12周末氯氮平组显著改善BPRS评分,利培酮组显著改善迟滞、思维障碍、敌对猜疑因子分,但氯氮平组较利培酮组敌对猜疑因子分减分率高。两组之间副反应评分有显著性差异,利培酮组明显低于氯氮平组,其余各项无显著性差异。结论 氯氮平较利培酮治疗敌对猜疑效果好,但利培酮较氯氮平副作用小,安全性较高。     

利培酮和氯氮平治疗伴抑郁症状的难治性精神分裂症对照研究

目的：比较利培酮和氯氮平对伴抑郁症状的难治性精神分裂症疗效。方法：共70例难治性精神分裂症患者随机服用利培酮和氯氮平治疗。利培酮组34例,氯氮平组36例;伴有抑郁症状者39例,利培酮组17例,氯氮平组22例。治疗12周。分别于治疗前、治疗4、8、12周末采用阳性与阴性症状量表（PANSS）,汉密尔顿抑郁量表（HAMD）及功能大体评定量表（GAF）评定疗效。结果：两组PANSS、HAMD和GAF评分在治疗12周均有显著改善;两组间比较差异无显著性。有、无抑郁症状组在治疗4、8、12周末的HAMD总分与治疗前比较均显著减少。结论：抑郁症状不影响难治性精神分裂症的疗效;利培酮和氯氮平对伴抑郁症状的难治性精神分裂症均有效。     

Clozapine augmented with risperidone in the treatment of schizophrenia: a randomized, double-blind, placebo-controlled trial

OBJECTIVE: The authors evaluated the efficacy and safety of augmenting clozapine with risperidone in patients with treatment-resistant schizophrenia. METHOD: In a randomized, double-blind, placebo-controlled 12-week trial, 40 patients unresponsive or partially responsive to clozapine monotherapy received a steady dose of clozapine combined with either placebo (N=20) or up to 6 mg/day of risperidone (N=20). Patient psychopathology was assessed at 2-week intervals with the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), among other measures. Movement disorders were assessed with the Simpson-Angus Rating Scale. RESULTS: From baseline to week 6 and week 12, mean BPRS total and positive symptom subscale scores were reduced significantly in both groups, but the reductions were significantly greater with clozapine/risperidone treatment. Reductions in SANS scores were also significantly greater with clozapine/risperidone treatment than with clozapine/placebo. The adverse event profile for clozapine/risperidone treatment was similar to that for clozapine/placebo. Simpson-Angus Rating Scale scores were lower with clozapine/risperidone treatment throughout the trial but increased to approach those of clozapine/placebo treatment at week 12. Clozapine/risperidone treatment did not induce additional weight gain, agranulocytosis, or seizures compared with clozapine/placebo treatment. CONCLUSIONS: In patients with a suboptimal response to clozapine, the addition of risperidone improved overall symptoms and positive and negative symptoms of schizophrenia. The combination appears to be safe and well tolerated. Augmentation of clozapine with risperidone may provide additional clinical benefit for patients who are nonresponsive or only partially responsive to clozapine alone.     

Service use and costs of treating schizophrenia with atypical antipsychotics

BACKGROUND: The high acquisition cost of the atypical antipsychotics has prompted their closer clinical and economic evaluation. This study aims to examine the financial implications of using atypical antipsychotics in a defined catchment area sample of patients with schizophrenia. METHOD: Service costs over a 10-month period were compared between groups of patients fulfilling DSM-IV criteria for schizophrenia who were taking different atypical antipsychotic agents. RESULTS: All patients studied were taking clozapine (N = 31). risperidone (N = 19), or olanzapine (N = 41). Clozapine was used in more chronic patients, while risperidone and olanzapine were prescribed in both chronic and recently diagnosed cases. After background group differences were controlled for, patients on risperidone treatment incurred the lowest costs. The monthly costs for the clozapine and olanzapine groups were higher than for risperidone by US $246 and US $566, respectively. CONCLUSION: Clozapine was reserved for more severe forms of schizophrenia, but its cost impact was relatively low. Risperidone, as prescribed in ordinary practice, may be more cost-effective than olanzapine.     

Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment

OBJECTIVE: When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) investigation. METHOD: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone in phase 1 or 1B of the trials, primarily because of inadequate efficacy, were randomly assigned to open-label treatment with clozapine (N=49) or blinded treatment with another newer atypical antipsychotic not previously received in the trial (olanzapine [N=19], quetiapine [N=15], or risperidone [N=16]). RESULTS: Time until treatment discontinuation for any reason was significantly longer for clozapine (median=10.5 months) than for quetiapine (median=3.3), or risperidone (median=2.8), but not for olanzapine (median=2.7). Time to discontinuation because of inadequate therapeutic effect was significantly longer for clozapine than for olanzapine, quetiapine, or risperidone. At 3-month assessments, Positive and Negative Syndrome Scale total scores had decreased more in patients treated with clozapine than in patients treated with quetiapine or risperidone but not olanzapine. One patient treated with clozapine developed agranulocytosis, and another developed eosinophilia; both required treatment discontinuation. CONCLUSIONS: For these patients with schizophrenia who prospectively failed to improve with an atypical antipsychotic, clozapine was more effective than switching to another newer atypical antipsychotic. Safety monitoring is necessary to detect and manage clozapine's serious side effects.     

利培酮对精神分裂症患者社会功能的研究

目的:比较利培酮与氯氮平治疗的精神分裂症患者出院后社会功能状况,方法:随机抽取30例服用利培酮,30例服用氯氮平的精神分裂症患者,用阳性症状和阴性症状量表(PANSS), 明精神病评定量表(BPRS),不良反应症状量表(TESS)评定.出院后半年用社会功能缺陷量表(SDSS)评定,并与某些因素进行相关分析及多元逐步回归分析.结果:半年随访发现,服用利培酮的精神分裂症患者在职业工作,婚姻职能,父母职能和社会退缩等社会功能方面明显好于氯氮平,多元逐步回归分析显示,影响社会功能的因素为经济损失多,男性,不能积极参加组织活动,不能与他人和睦相处,BPRS评分高者社会功能差,服用氯氮平的比利培酮差.结论:利培酮和氯氮平相比,治疗的优势主要不在于副反应方面,而在于能较好地改善社会功能.