氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者糖、脂代谢及体质量的影响

目的 探讨氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者的糖、脂代谢和体质量的影响。方法 对服用氯氮平（89例，氯氮平组），服用氟哌啶醇（87例，氟哌啶醇组）及服用氯丙嗪（83例，氯丙嗪组）治疗的慢性精神分裂症患者于治疗前后的不同时间进行血糖、胰岛素、血脂及体质量测定，并做相关因素分析。结果 氯氮平组治疗第90天和第180天空腹血糖异常（空腹血浆血糖〉7.0mmo/L）的发生率分别为8％及24％，氟哌啶醇组分别为1％和2％，氯丙嗪组分别为1％及4％。治疗第90天氯氮平组和氯丙嗪组的空腹及餐后2h血糖浓度均较治疗前升高，治疗第180天的血糖浓度高于第90天，氟哌啶醇组各时点的变化则不明显；差异均有统计学意义（P均〈0．01）。治疗第90天，氯氮平组的体质量平均高于治疗前5．5％，氯丙嗪组高于治疗前4．8％；治疗第180天两组分别高于治疗前9．1％和7．4％；氟哌啶醇组则无明显变化；三组间的差异有统计学意义（P〈0．01）。三组患者治疗第180天的胰岛素浓度均高于治疗前，差异均有统计学意义（P均〈0．01），但三组间的差异无统计学意义（P〉0．05）。氯氮平组和氯丙嗪组的胆固醇和甘油三酯浓度均高于治疗前，差异均有统计学意义（P均〈0．01），氟哌啶醇组则无明显变化。治疗第180天氯氮平组和氯丙嗪组患者血糖、胰岛素、血脂浓度与体质量均有一定相关性（r=0．23-0．39）；氯氮平组的血糖、体质量、血脂代谢还与血药浓度呈显著性相关（r=0．28-0．62），差异均有统计学意义（P〈0．05或〈0．01）。结论 氯氮平和氯丙嗪治疗影响慢性精神分裂症患者的糖、脂代谢及体质量。     

利培酮对精神分裂症首次发病患者血清脑源性神经营养因子水平的影响

目的：探讨利培酮对首发精神分裂症患者血清脑源性神经营养因子（BDNF）水平的影响。方法：采用酶联免疫吸附法测定40例首发精神分裂症患者（患者组）在给予利培酮治疗前和治疗8周后的血清BDNF水平,并与40名正常人（正常对照组）的血清BDNF水平进行比较。结果：治疗前患者组血清BDNF水平显著低于正常对照组（P〈0．05）,治疗8周,患者组血清BDNF水平较治疗前明显升高（P〈0．01）;与正常对照组差异无统计学意义（P〉0．05）。患者组中有阳性家族史者（8例）与阴性家族史者（32例）之间血清BDNF水平差异无统计学意义（P〉0．05）。患者组治疗前后血清BDNF水平与阳性与阴性症状量表评分（r=0．283,r=0．09;P〉0．05）无显著相关;两组血清BDNF水平与年龄（r=-0．142,r=-0．122;P〉0．05）、体质量指数（r=-0．112,r=0．039;P〉0．05）均无显著相关。结论：首发精神分裂症患者可能存在血清BDNF水平低下,利培酮治疗可提高其血清BDNF水平。     

氯丙嗪和氯氮平对首发精神分裂症血糖影响的随访观察

目的：探讨氯丙嗪和氯氮平对首发精神分裂症血糖水平的影响。方法：对160例首发精神分裂症患者随机给予氯丙嗪或氯氮平治疗，于治疗前及治疗12周、26周、52周末分别测定一次空腹血糖。结果：首发精神分裂症患者治疗前合并高血糖者占8．75％，氯丙嗪治疗52周末时血糖水平增高，而氯氮平治疗12周后血糖水平即增高，治疗26周时，氯氮平组合并高血糖者显著高于氯丙嗪组(χ^2=4．81，P=0．03)。结论:氯氮平治疗期间应定期监测血糖。     

首次使用氯丙嗪和利培酮对精神分裂症患者血糖代谢的影响

目的 探讨首次使用氯丙嗪和利培酮对精神分裂症患者血糖代谢的影响。方法 114例住院精神分裂症患者随机分为氯丙嗪组和利培酮组。治疗前及治疗后第1、2．3、6个月及12个月后分别测定多项血糖指标浓度,并进行对照分析。结果 治疗3个月时的空腹血糖（FPC）、2小时糖耐量（2HPG）及餐后2小时血糖（2HPBG）,以及治疗6个月时的糖化血红蛋白（HbAlc）浓度明显高于治疗前;治疗12个月后有15．79％的患者发生血糖调节功能受损（ICR）,其中氯丙嗪组为11．65％,明显高于利培酮组6．32％;随着精神病发病年龄的增长,上述血糖浓度也逐步提高;发病年龄、疗前糖耐量及脂蛋白p浓度接近正常上限可能是ICR的诱因。结论 首次使用氯丙嗪和利培酮即可影响糖代谢,应早期监测血糖,早期干预。     

首发精神分裂症症状严重度预测利培酮的6周疗效

目的通过对首发精神分裂症患者治疗前症状的严重度预测利培酮治疗6周后的疗效。方法对62例服用利培酮（3．9±0．9mg／d）的首发精神分裂症患者在治疗前和治疗6周末分别采用简明精神病量表（BPRS）评定。结果疗前BPRS总分与6周BPRS减分值相关（r=0．786,P〈0．01）;焦虑忧郁、缺乏活力、思维障碍、激活性和敌对因子的疗前分,分别与6周减分值呈正相关（r=0．928、0．425、0．645、0．939、0．684,P〈0．01）。结论疗前总症状或各症状群越重,利堵酮治疗6周后的相关症状改善越显著。     

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．     

氨磺必利与利培酮治疗首发精神分裂症的对照研究

目的比较氨磺必利与利培酮治疗首发精神分裂症的疗效和安全性。方法按就诊先后顺序将首发精神分裂症患者分为研究组和对照组,分别给予氨磺必利和利培酮治疗8周。于治疗前及治疗后第4、8周末采用阳性与阴性综合征量表（PANSS）评定患者的疗效,以治疗中需处理的不良反应症状量表（TESS）评定患者的不良反应。结果治疗后第4、8周末,两组PANSS量表总分及分量表评分较治疗前均有显著降低（P〈0．05,P〈0．01）;研究组有效率93．8％,显效率71．9％;对照组有效率为90．6％,显效率68．8％,两组比较无显著性差异（P〉0．05）。研究组和对照组药物不良反应均较少。结论氨磺必利是一种安全有效的抗精神病药物,对治疗首发精神分裂症疗效与利培酮相当。     

氯丙嗪和利培酮对精神分裂症血糖调节功能的早期影响

目的探讨氯丙嗪和利培酮对精神分裂症血糖调节功能的早期影响。方法对符合中国精神障碍分类与诊断标准第3版（CCMD-3）诊断标准,且未曾接受精神药物治疗的精神分裂症198例,按入院顺序分为氯丙嗪组（103例）和利培酮组（95例）。于治疗前及治疗后第1、3及6个月末分别测定空腹血糖（FPG）、2h糖耐量试验（2hPG）、血脂及体重指数。结果氯丙嗪组在治疗6个月时,其血糖调节功能受损（IGR）为15．53％、利培酮为7．37％;随着治疗时间延长,FPG和2hPG浓度有逐渐增高趋势;同时,≥40岁组明显高于〈40岁组,并与胆固醇、甘油三酯浓度及体重指数量正相关。结论FIG和2hPG浓度增高是IGR的早期表现,选择影响糖代谢较小的抗精神病药物治疗精神分裂症可减少其IGR的可能性。     

奥氮平与利培酮对青少年精神分裂症首发患者糖、脂代谢的影响对照研究

目的探讨奥氮平与利培酮对首发青少年精神分裂症患者空腹血糖及血脂水平的影响。方法70例符合入组标准的精神分裂症患者被随机分为奥氮平组（32例）和利培酮组（38例）。治疗观察6周。两组患者在治疗前及治疗第6周末分别检测空腹血糖、总胆固醇、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、身高、体质量并计算体质量指数。结果（1）治疗第5周末，奥氮平组患者的体质量指数、血糖、甘油三脂及低密度脂蛋白胆固醇水平均升高，与治疗前的差异有统计学意义（P〈0．05）；两组患者的体质量指数差值、血糖差值及甘油三脂差值间比较有统计学意义（P〈0．05）。（2）两组患者男女间各项指标差值的比较均无统计学意义（P〉0．05）。（3）奥氮平组患者体质量的增加与血糖、甘油三脂有显著相关关系（P〈0．05）。结论奥氮平对青少年精神分裂症患者糖、脂代谢的影响明显大于利培酮。     

齐拉西酮与利培酮治疗首发精神分裂症的对照研究

目的比较齐拉西酮与利培酮治疗首发精神分裂症的疗效及安全性。方法80例首发精神分裂症患者,随机分为齐拉西酮组和利培酮组,疗程8周。采用阳性和阴性症状量表（PANSS）、临床总体印象量表（CGI）及治疗中需处理的不良反应症状量表（TESS）,在治疗前及治疗第1、2、4、6、8周末分别评定疗效和副反应。结果（1）齐拉西酮组PANSS总分、阴性症状分、一般病理分从治疗第2周末起,阳性症状分从第3周末起,较治疗前下降（P〈0．05～0．01）;利培酮组PANSS总分、阳性症状分、一般病理分从治疗第2周末起,阴性症状分从第3周末起,较治疗前下降（P〈0．05～0．01）;齐拉西酮组从第2周末起阴性症状分低于利培酮组（P〈0．05）,而阳性症状分高于利培酮组（P〈0．05）;（2）治疗后2周末起,两组CGI—SI分较治疗前下降（P〈0．05～0．01）;治疗后各时点,两组CGI—SI分无显著差异（P〉0．05）;（3）治疗第8周末,齐拉西酮组、利培酮组临床总有效率分别为86．84％、88．57％,差异无显著性（P〉0．05）;（4）齐拉西酮组、利培酮组不良反应发生率分别为36．84％、54．28％,差异无显著性（P〉0．05）;利培酮组静坐不能、异常泌乳和／或闭经、肌张力增高、体重增加的发生率高于齐拉西酮组,差异有显著性（P〈0．05～0．01）。结论齐拉西酮与利培酮治疗精神分裂症总体疗效相当;齐拉西酮对阴性症状疗效优于利培酮,而对阳性症状控制弱于利培酮,不良反应较利培酮轻,耐受性好。     

利培酮与氯丙嗪对精神分裂症认知功能的影响

目的：比较利培酮和氯丙嗪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62例随机分为利培酮组与氯丙嗪组,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3例,59例患者在8周治疗后PANSS总分明显下降,但两组之间差异无显著性。利培酮组的WAIS－CT、CMS总分均明显高于氯丙嗪组,差异有显著性。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丙嗪。     

Metabolic syndrome in first episode schizophrenia - a randomized double-blind controlled, short-term prospective study

BACKGROUND: Although the treatment of schizophrenia, arguably one of the most devastating diseases today, has been immensely helped by the advent of second-generation antipsychotics, they have come at a considerable cost - the metabolic syndrome (MetS). This adverse effect has been described with several antipsychotics to range between 20%-60%, at least double the prevalence in the general population. METHODS: All consecutive patients with first episode schizophrenia at our referral psychiatric hospital were recruited in an extensive prospective randomized, double-blind controlled study including measures of waist circumference (WC), blood pressure (SBP/DBP), triglyceride (TGL), high-density lipoproteins (HDL) and fasting blood sugar (FBS) levels and randomized to receive either, haloperidol, olanzapine or risperidone. The prevalence of MetS was assessed based on two criteria- ATP IIIA and criteria of International Diabetes Federation (IDF). This was compared with a gender, age, exercise and diet matched healthy control group. RESULTS: The analysis of 99 patients showed a prevalence of MetS as 10.1% and 18.2% as assessed by ATP IIIA and IDF criteria respectively. The prevalence of MetS in our sample of patients with schizophrenia is at least five times as high when compared to the matched healthy control group. Olanzapine had maximum prevalence of MetS at 20-25% followed by risperidone at 9-24% and haloperidol at 0-3%. DISCUSSION: Metabolic syndrome is highly prevalent among treated patients with first episode schizophrenia. Early monitoring of patients on atypical antipsychotics can possibly play an important role in early detection and hence prevention of the metabolic syndrome.     

抗精神病药对血脂和载脂蛋白的影响

目的 :比较氯丙嗪、氯氮平及利培酮对精神分裂症患者血脂及载脂蛋白的影响。　方法 :采用全自动生化仪对单用氯丙嗪、氯氮平或利培酮治疗的精神分裂症患者各 30例进行治疗前后的血脂及载脂蛋白测定及对比分析。　结果 :氯丙嗪、氯氮平、利培酮均可引起女性精神分裂症患者胆固醇(TG)、载脂蛋白B(apoB)明显升高 ,氯氮平组升高更为明显。氯丙嗪、氯氮平均可引起男、女性精神分裂症患者甘油三脂 (TC)明显升高 (P <0 .0 5 )。　结论 :氯丙嗪、氯氮平、利培酮均可导致精神分裂症患者的脂类代谢异常 ,在治疗精神分裂症的同时应及早采取相应的预防措施     

利培酮与氯丙嗪治疗难治性精神分裂症对照研究

目的：比较利培酮与氯丙嗪治疗难治性精神分裂分裂症的疗效。方法：将符合入组条件的病人随机分为2组,分别服用利培酮或氯丙嗪治疗12周,用阳性与阴性症状量表（PANSS）和副反应量表（TESS）评定疗效和副反应情况。结果：利培且总有效率为71．4％,明显高于氯丙嗪组42．9％,经统计学处理差异有显著性（P＜0．05）,结论：利培酮对难治性精神分裂症的 疗效优于氯丙嗪,对阴性症状效果更佳。     

抗精神病药对男性精神分裂症患者垂体-性腺轴的影响

目的:研究氯丙嗪、利培酮、奎硫平及奥氮平对男性精神分裂症患者垂体性腺轴的影响。方法:88例首发男性精神分裂症患者随机分为氯丙嗪组、利培酮组、奎硫平组及奥氮平组,检测治疗前、治疗4周及8周血清促卵泡素(FSH)、黄体生成素(LH)、催乳素(PRL)、睾酮(T)的水平变化。结果:氯丙嗪组治疗8周后,血清PRL水平显著高于治疗前。利培酮组在治疗4周及8周后PRL水平均显著高于治疗前,治疗8周后T及LH水平显著低于治疗前。奎硫平组在治疗4周及8周后血清PRL、LH、T水平与治疗前比较差异均无显著性。奥氮平组治疗4周后PRL水平显著高于治疗前,治疗8周后即与治疗前差异无显著性。结论:奎硫平对垂体性腺轴激素水平无明显影响。     

奥氮平与利培酮治疗首发精神分裂症对照研究

目的 比较奥氮平与利培酮治疗首发精神分裂症的疗效及不良反应。方法 随机将符合CCMD-2R精神分裂症的诊断标准70例患者进入奥氮平或利培酮组接受治疗,分别在治疗0、1、2、4、6、8周评定PANSS和TESS量表,在0、4、8周检查心脑电图和肝肾功能,在0、8周检查血催乳素和空腹血糖。结果 奥氮平与利培酮疗效相当,奥氮平能迅速减轻精神症状,其产生的不良反应少、严重程度轻,很少引起血催乳素变化;利培酮会显著提高血催乳素水平。结论 奥氮平对首发精神分裂症治疗安全有效。     

Treatment of cognitive impairment in early psychosis: a comparison of risperidone and haloperidol in a large long-term trial

OBJECTIVE: Cognitive impairment is a major determinant of functional outcome in schizophrenia. Treatment of cognitive impairment at the time of the first episode may have the potential to change functional outcomes of the illness. This study examined changes associated with treatment with risperidone compared with haloperidol in aspects of cognitive functioning known to be associated with functional outcomes. The study was conducted in a large group of patients experiencing their first episode of schizophrenia. METHOD: Cognitive assessments were conducted in 533 patients experiencing their first episode of schizophrenia or a related psychosis who had been randomly assigned to receive low doses of risperidone or haloperidol. The cognitive assessments were repeated at several different follow-up intervals; 359 patients were reexamined at the 3-month follow-up. The assessments included examinations of verbal and visuospatial episodic memory, vigilance, executive functioning, processing speed, and verbal fluency. Patients' clinical symptoms were also rated with the Positive and Negative Syndrome Scale. RESULTS: Improvements from baseline were found in the risperidone-treated patients for episodic memory, verbal fluency, vigilance, executive functioning, and visuomotor speed. Haloperidol-treated patients also showed improvements from baseline in episodic memory, vigilance, and visuomotor speed but not in executive functioning or verbal fluency. Comparison of differential treatment effects on a composite measure of cognitive functioning found that risperidone was significantly more beneficial than haloperidol after 3 months of treatment. Changes in Positive and Negative Syndrome Scale scores were correlated overall with improvement in the haloperidol-treated patients but not in the risperidone-treated patients. CONCLUSIONS: Treatment with risperidone at the time of the first episode of schizophrenia is associated with wide-ranging improvements in cognitive functioning. Overall improvement is significantly greater with risperidone than with haloperidol. Further, cognitive improvement associated with treatment with risperidone was not influenced by changes in symptoms, but that relationship was significant in haloperidol-treated patients.     

Immediate effects of risperidone on cerebral activity in healthy subjects: a comparison with subjects with first-episode schizophrenia

OBJECTIVE: To test the hypothesis that administration of risperidone to healthy subjects produces reductions in metabolism in the frontal cortex similar to those produced by administration of risperidone to patients experiencing a first episode of schizophrenia. METHODS: Positron emission tomography was used to measure the changes in regional metabolism produced by a single 2-mg dose of risperidone and by placebo, administered under randomized, double-blind conditions, in 9 healthy subjects. Conjunction analysis was used to identify those cerebral sites where changes in metabolism in the healthy subjects coincided with similar changes in metabolism observed in patients with schizophrenia. RESULTS: Compared with placebo, risperidone produced reductions in metabolism in the left lateral frontal cortex and right medial frontal cortex in healthy subjects. Conjunction analysis revealed that these changes occurred at locations similar to the loci of change produced by risperidone in patients with schizophrenia. CONCLUSION: Because the reduction in metabolism in the medial frontal cortex produced by risperidone is associated with alleviation of positive symptoms in patients with schizophrenia, the observation of a reduction in metabolism at a similar site in healthy subjects supports the hypothesis that the antipsychotic effect of risperidone arises, at least in part, from a physiologic effect that occurs in both patients with schizophrenia and healthy subjects.     

利培酮与氯丙嗪对代谢影响随访研究

目的：研究氯丙嗪与利培酮对精神分裂症患者血糖、血脂和体质量的影响。方法：198例精神分裂症患者随机分为氯丙嗪组与利培酮组,随访1年,采集患者空腹血糖、总胆固醇、和体质量的数据。结果：氯丙嗪组和利培酮组总胆固醇、三酰甘油、空腹血糖、糖化血红蛋白、体质量、体质量指数在治疗后均显著升高;以氯丙嗪组更显著为高。结论：氯丙嗪与利培酮对血糖、血脂和体质量的影响不同,但都可使之升高。     

Risperidone versus olanzapine among patients with schizophrenia participating in supported employment: Eighteen-month outcomes

This study compares the efficacy and tolerability of olanzapine versus risperidone among patients with schizophrenia who are established in outpatient psychiatric care and entering supported employment. A multicenter, randomized, double-blind trial was conducted among 107 outpatients with schizophrenia, who were cross-titrated to flexible dose risperidone or olanzapine over 2 weeks. Clinical endpoints included time to hospitalization and persistence on assigned medication. Weight, laboratory tests, psychopathology, neurologic side effects, social adjustment and role functioning were assessed at 3–6 month intervals. Data were analyzed first by randomized treatment, and then reassessed controlling for prior medication treatment. The proportion of patients on assigned medication at 18 months was 30.9% for risperidone and 37.3% for olanzapine. Mean doses were 6.4 ± 3.2 mg daily for risperidone, and 17.0 ± 5.0 mg daily for olanzapine. The groups did not differ significantly in time to medication discontinuation, first hospitalization or first employment. There were few differences in psychopathology, laboratory, or neurological assessments between groups at 18 months. Patients randomized to olanzapine gained modestly more weight. Controlling for pre-randomization medication suggested improvement in some aspects of psychopathology from switching medications; however, switching from olanzapine to risperidone was associated with more hospitalizations. Risperidone and olanzapine have similar efficacy and tolerability in patients with schizophrenia who are participating in supported employment. Randomization to olanzapine was associated with more weight gain, but randomization from olanzapine to risperidone appeared to be associated with a greater likelihood of hospitalization. Careful monitoring of metabolic effects and participation in supported employment may have contributed to minimal weight gain and metabolic effects.