新型抗精神病药的研发进展

现存的各类抗精神病药物的不良反应繁多，且控制症状的效能仍有很大局限，致使相当数量的患者成为难治性案例。本文对近年国外研究出的新型药物的进展进行系统探讨，以期提高现有治疗水平。     

新型抗精神病药的临床治疗研究进展

新型抗精神病药(Modernantipsychotics,MA)如氯氮平、奥氮平、喹硫平、利培酮、齐拉西酮和阿立哌唑等正逐渐取代常规抗精神病药(Conventionalantipsychotics,CA),但MA的治疗优势似无确凿证据,本文综述近年来有关资料,从作用途径、临床有效性、耐受性和不良反应等方面进行比较,结果表明,两类药物在临床有效性和耐受性方面的差异很小,且有些MA对代谢系统和心血管系统的长期不良反应不容忽视。临床使用时应全面权衡这两类药物的利弊。     

新型抗精神病药阿立哌唑的临床评价

目的：探讨阿立哌唑的临床特点及其应用前景,为临床提供参考。方法：通过查阅、学习国内外有关文献,加深对阿立哌唑的临床作用及不良反应的了解;通过收集北京市近3年来非典型抗精神病药的应用数据,计算分析其应用趋势。结果与结论：阿立哌唑疗效确切,不良反应少,安全性高,应用人群逐年增多,临床应用前景广阔。     

新型抗精神病药奥氮平的临床应用

奥氮平是一种新型非典型抗精神病药 ,对多种神经递质受体具有亲和力。口服吸收迅速完全 ,生物利用度高。血浆T1/2 长 ,每日服药 1次。奥氮平对于多种精神障碍具有良好的临床治疗效果。其耐受性及安全性好     

抗精神病药临床应用分析

目的：了解抗精神病药临床应用情况及发展趋势,为合理用药提供依据。方法：以限定日剂量（DDD）为指标,对本院2007～2009年抗精神病药的用药金额、用药频度进行分析。结果：3年来抗精神病药品种数稳定,消耗金额增长。平均年增长率为33%,抗精神病药占药品总金额的比例有逐年增长趋势。日用药金额逐年增长,年增长率达到15.5%。结论：临床使用的抗精神病药已经由传统的经典抗精神病药转向以利培酮、喹硫平、奥氮平、阿立哌唑、齐拉西酮、氯氮平为主的非典型抗精神病药。     

新型抗精神病药临床再评价

新型抗精神病药（Modern antipsychotics，MA）氯氮平自1988年进入临床后，以不良反应特别是锥体外系症状少，对难治性急、慢性精神分裂症疗效显的特点，致使常规抗精神病药（Conventional antipsychoties，CA）如吩噻嗪类（氯丙嗪等）、噻吨类（如氯普噻吨）和丁酰苯类（如氟哌啶醇）的治疗地位下降。近年来，奥氮平、喹硫平、利培酮、齐拉西酮、阿立哌唑等MA上市，其化学结构、药理机制和用途各不相同，但均在临床得以广泛应用并受到推荐。本综合新近研究，对MA与CA的有效性、安全性进行比较。     

新型非典型抗精神病药齐拉西酮

通过文献检索综述了齐拉西酮的作用机制、药代动力学及临床评价。齐拉西酮是一种安全、有效的非典型性抗精神病药，用于治疗精神分裂症和分裂情感性障碍。     

长期住院精神病患者抗精神病药应用研究

抗精神病药主要用于治疗精神分裂症,以及其它的精神病性精神障碍。科学、合理的使用能够有效地控制患者的精神运动兴奋、幻觉、妄想和敌对情绪等思维异常行为。本文对长期住院精神病患者的抗精神病药应用状况进行了深入的调查和分析,为抗精神病药物的研究提供一些借鉴。     

抗精神病药物引起女性精神分裂症患者麻痹性肠梗阻的回顾性分析

目的：探讨抗精神病药物引起女性精神分裂症患者发生麻痹性肠梗阻的临床特点及治疗。方法：采用回顾性研究方法,对2010年1月—3月本院9例发生麻痹性肠梗阻的住院女性精神分裂症患者的临床资料进行分析,麻痹性肠梗阻均经立位腹部X平片确诊。结果：2例在麻痹性肠梗阻前2~3 d未排便（其中1人在腹部检查中观察到肛门排气）,另2例在麻痹性肠梗阻前腹泻1~2 d,其余5例均在麻痹性肠梗阻发生的当日或前1日排便。发生麻痹性肠梗阻时,9例均出现呕吐,其中的6例伴有腹痛,另3例伴有腹胀。9例压痛均不明显,7例腹部叩诊呈鼓音,6例肠鸣音减弱或消失。通过禁食、胃肠减压及应用抗生素等治疗,9例精神分裂症患者麻痹性肠梗阻均治愈。结论：抗精神病药物致女性精神分裂症患者发生麻痹性肠梗阻的症状中,以呕吐为典型症状,多数伴有腹痛,部分有腹胀;在体征中腹部压痛不明显。保守疗法可取得较好疗效。     

Safety profile of iloperidone in the treatment of schizophrenia

The use of botulinum toxin to treat cervical dystonia (CD) has dramatically improved the quality of life of patients with this disabling, often painful disease. Two forms of type A toxin (BOTOX® and Dysport®) and one form of type B toxin (MyoBloc®) are available in some parts of the world to treat patients with CD. The literature supports the efficacy of each in reducing the pain and movement of cervical dystonia. The dosing and side effects vary between the toxins. The potential availability of several forms of toxin will allow physicians to offer further treatment options to patients with CD. However, it is incumbent on the treating physicians to have a working knowledge of the different serotypes, different doses used of each formulation of each serotype, the side effect profile of each product and the potential for anti-body formation for each form of toxin.     

Development of novel therapy of schizophrenia in children and adolescents

Introduction: Typical and atypical antipsychotics are efficacious treatments for early-onset schizophrenia (EOS) with very subtle differences in their efficacy. Therefore, when choosing an antipsychotic, the side-effect profile of the individual antipsychotic needs to be taken into account. There is a growing body of neurobiological and genetic evidence for early-onset patients, but these findings have not yet translated into the clinic.

Areas covered: The authors summarize the current treatment options for EOS and discuss the novel treatment options that are under evaluation. The authors focus specifically on Phase II and Phase III clinical trials.

Expert opinion: Currently, there are no truly groundbreaking pharmacological treatment options emerging in EOS. There are several newer antipsychotic agents (iloperidone, lurasidone, asenapine, blonanserin) that are currently in clinical trials. It is unclear whether therapeutic efficacy of any of these agents will be superior or even similar to the existing treatment and the main differentiating factor between individual drugs remains to be their side-effect profile. Beyond these antipsychotics, oxytocin and N-acetylcysteine are the only new pharmacological treatment options that are being evaluated in EOS. Therefore, a major change in the treatment development paradigm is necessary to identify novel and efficacious drugs.     

国产喹硫平与氯氮平治疗精神分裂症的疗效比较

目的 :探讨喹硫平治疗精神分裂症的疗效及不良反应。方法 :6 0例精神分裂症病人分为 2组 ,喹硫平组 30例 ,男性 19例 ,女性 11例 ,年龄 (37±s8)a ,给予喹硫平 ,氯氮平组 30例 ,男性 2 0例 ,女性10例 ,年龄 (36± 8)a ,给予氯氮平 ,2组开始剂量约为 5 0mg·d- 1,以后视病情调整 ,分别为 (42 3± 2 0 )mg·d- 1和 (415± 18)mg·d- 1,分 2次口服 ,共治疗 6wk ,采用阳性症状与阴性症状量表 (PANSS)评定临床疗效 ,同时用不良反应症状量表 (TESS)评定不良反应。结果 :喹硫平组的有效率达 87% ,与氯氮平组 (6 0 % )比较无显著差异 (P >0 .0 5 )。喹硫平组的不良反应中活动减少、视物模糊、便秘、流涎、头晕、体重增加的发生率显著少于氯氮平组 (P <0 .0 1或P <0 .0 5 )。结论 :国产喹硫平治疗精神分裂症的疗效是肯定的 ,与氯氮平相似 ,不良反应轻、少 ,是一种安全、有效的抗精神病药     

Sertindole for the treatment of schizophrenia

Importance of the field: Despite considerable progress in the pharmacological treatment of schizophrenia, unmet needs remain concerning refractory patients, as well as improvement of negative symptoms, cognition, quality of life, adherence and tolerability. Sertindole, a second-generation antipsychotic with high affinity for dopamine D₂, serotonin 5-HT_2A, 5-HT_2C, and α₁-adrenergic receptors, is the first phenylindole-derived antipsychotic agent.

Areas covered in this review: Pharmacodynamics, pharmacokinetics, clinical efficacy, safety and cost-effectiveness of sertindole are covered based on a literature review (PubMed) from 1990 to 2010. Pivotal as well as supportive randomized controlled trials are reviewed along with observational and/or naturalistic safety studies.

What the reader will gain: This review of sertindole will allow the reader to determine the place for sertindole in the schizophrenia treatment landscape.

Take home message: Studies conducted so far suggest a beneficial effect of sertindole on positive and negative symptoms as well as on cognition, relapse prevention and quality of life. There is also some evidence for the treatment of refractory patients. Sertindole induces moderate weight gain, with few extrapyramidal symptoms and metabolic changes. More head-to-head comparisons with other second-generation antipsychotics are, however, still needed as well as further clarification on cardiac safety.     

Anti-inflammatory strategies in the treatment of schizophrenia

Schizophrenia is a major mental illness with a lifetime prevalence of about 1%. Antipsychotic drugs, with a primary mechanism of action that involves dopamine receptor blockade, are the mainstay in the treatment of the disorder. However, despite optimum antipsychotic treatment, few patients return to pre-morbid levels; the treatment deficit includes refractory positive symptoms, negative symptoms, mood impairments, cognitive impairments, social impairments, and/or a variety of medication-related adverse effects, including extrapyramidal symptoms, metabolic disturbances, hyperprolactinemia, and others. To address these, antipsychotic treatment has been augmented with psychosocial interventions, cognitive rehabilitation, different kinds of electrical and magnetic brain stimulation, and a large range of drugs from the neuropsychiatric as well as, surprise, the general medical pharmacopeia. The pleomorphic pathophysiology of schizophrenia includes abnormalities in immunological and inflammatory pathways, and so it is not surprising that anti-inflammatory drugs have also been trialed as augmentation agents in schizophrenia. This article critically examines the outcomes after augmentation with conventional anti-inflammatory interventions; results from randomized controlled trials do not encourage the use of either aspirin (1000 mg/day) or celecoxib (400 mg/day), both of which have been studied for this indication during the past decade and a half.     

长期服用盐酸苯海索治疗对精神分裂症患者认知功能的影响

目的 探讨盐酸苯海索抗胆碱治疗对精神分裂症认知功能的影响.方法 服用第二代抗精神病药合并盐酸苯海索治疗大干3月的60名精神分裂症病人按照服药种类配对分为研究组和对照组各30名.研究组在4周内逐渐停用盐酸苯海索,对照组盐酸苯海索剂量保持不变,分别在基线和一月后进行威斯康星卡片分类测验(WCST)、霍普金斯词汇学习测验(H...