阿立哌唑对女性精神分裂症患者服用奥氮平引起的代谢综合征的影响分析

目的:探析阿立哌唑对女性精神分裂症患者服用奥氮平引起的代谢综合征的影响。方法:选取广东省惠州市第二人民医院于2017年5月~2018年5月收治的64例服用奥氮平引起代谢综合征的女性精神分裂症患者作为主要对象,采用数字随机表达法分为观察组和对照组,各32例。观察组采用阿立哌唑治疗,对照组采用利培酮治疗,比较两组代谢综合征及精神症状的治疗效果。结果:治疗前观察组与对照组的腰围、BMI指数、空腹血糖、甘油三酯、高密度脂蛋白等代谢指标无明显差异(P>0.05);治疗后观察组的腰围、BMI指数、空腹血糖、甘油三酯等代谢指标均明显低于对照组(P<0.05);治疗前观察组与对照组的PANSS评分无明显差异(P>0.05),治疗后观察组的PANSS评分明显低于对照组(P<0.05)。结论:阿立哌唑可改善女性精神分裂症患者服用奥氮平引起的代谢综合征,且对精神分裂症的治疗效果佳。     

A randomized, 12-week study of the effects of extended-release paliperidone (paliperidone ER) and olanzapine on metabolic profile, weight, insulin resistance, and β-cell function in schizophrenic patients

Objective

To compare matched paliperidone-ER- and olanzapine-treated schizophrenic patients on measures of glucose and lipid metabolism.

Methods

Eighty hospitalized patients with schizophrenia (DSM-IV) were randomly assigned to treatment with paliperidone ER or olanzapine for a period of 12 weeks. At baseline and every 4 weeks, we assessed weight, subcutaneous fat, waist and hip circumferences, fasting glucose, insulin, glycohemoglobin A1, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and prolactin. We also assessed at every time point body mass index (BMI), homeostasis insulin resistance (HOMA-IR), and homeostasis β-cell function (HOMA-B).

Results

Thirty-three patients randomly assigned to paliperidone ER and 23 patients randomly assigned to olanzapine groups completed the entire 12-week treatment. Within-group analyses showed that fasting measures in both groups increased for weight, BMI, waist circumferences, hip circumference, subcutaneous fat, cholesterol, triglycerides, and prolactin. In contrast, fasting glucose, LDL, and HOMA-B increased during treatment only in the olanzapine group. We also detected significantly different serum prolactin levels at all time point between the paliperidone ER- and olanzapine-treated groups, as well as a statistical trend for HOMA-B to increase more in the olanzapine compared to paliperidone-ER group over the 12 weeks of the trial. We did not detect, however, differential drug effects over the 12 weeks of the trial on fasting measures of BMI, glucose, glycohemoglobin A1, insulin, HDL, LDL, cholesterol, triglyceride, or HOMA-IR.

Conclusion

This study reinforces the necessity of regularly monitoring metabolic parameters in patients with schizophrenia taking atypical antipsychotics, including paliperidone ER.     

Effects of second-generation antipsychotics on selected markers of one-carbon metabolism and metabolic syndrome components in first-episode schizophrenia patients

Purpose

Alterations in one-carbon metabolism (OCM) have been repeatedly reported in schizophrenia. However, there is a scarcity of studies addressing the effects of antipsychotics on selected OCM markers in schizophrenia and provided results are inconsistent.

Methods

We recruited 39 first-episode schizophrenia (FES) patients and determined serum profile of total homocysteine (tHcy), folate, vitamin B12, lipoproteins and glucose at baseline and after 12 weeks of treatment with second-generation antipsychotics (SGA) including olanzapine and risperidone in monotherapy.

Results

After 12 weeks of treatment, all patients had significantly higher body mass index (BMI), serum levels of total cholesterol (TC), low-density lipoproteins (LDL), triglycerides (TG) and tHcy together with significantly lower levels of folate and vitamin B12. The analysis of differences between SGA revealed the same biochemical alterations in patients treated with olanzapine as in the whole group, while those receiving risperidone had no statistically significant changes in serum folate, vitamin B12 and TG. There was a significantly higher increase in BMI and TC in patients treated with olanzapine in comparison with those treated with risperidone. Patients receiving olanzapine had a higher decrease in vitamin B12 than those assigned to the treatment with risperidone. Changes in folate, vitamin B12, tHcy and TC levels were significant only in males, even after Bonferroni correction. Multiple regression analysis revealed that changes in tHcy levels are associated with gender and baseline metabolic parameters (BMI, glucose, TC, LDL and HDL) but not with selected SGA.

Conclusions

These results indicate that SGA may influence OCM, especially in first-episode schizophrenia (FES) males.     

探讨奥氮平对首发精神分裂症伴肥胖患者认知功能、糖脂代谢及相关激素指标水平的影响

目的：探讨奥氮平对首发精神分裂症伴肥胖患者认知功能、糖脂代谢及相关激素指标水平的影响。方法：选取2015年3月至2017年5月某院收治的首发精神分裂症伴肥胖患者500例,采用随机数字表法分为观察组、对照组各250例。对照组患者给予利培酮,观察组在此基础上予以奥氮平,从小剂量（奥氮平片5 mg·d^-1,利培酮口腔崩解片1 mg·d^-1）开始,后逐渐加量,在1个月内达到治疗量（奥氮平片15~20 mg·d^-1,利培酮口腔崩解片4~6 mg·d^-1）。两组患者均治疗8周。应用阳性和阴性综合征量表（PANSS）、认知功能成套测验系统（MCCB）评估两组患者治疗前后症状、认知功能,并比较两组患者治疗前后体质量指数（BMI）、糖脂代谢指标[空腹血糖（FPG）、总胆固醇（TC）、低密度脂蛋白（LDL）、三酯甘油（TG）]、相关激素指标[泌乳素（PRL）、雌二醇（E₂）、睾酮（TESTO）],观察不良反应发生情况。结果：治疗8周后,两组患者PANSS评分均较治疗前显著下降（P<0.05）,组间PANSS评分及PANSS减分率比较差异无显著性（P>0.05）;MCCB测试中,观察组在连线测试、工作记忆、操作速度方面改善显著优于对照组（P<0.05）;治疗后两组BMI、FPG、TC、LDL、TG均增加,且观察组各指标水平均高于对照组（P<0.05）;两组治疗后PRL、E₂、TESTO水平均升高（P<0.05）,组间对比差异均无显著性（P>0.05）;两组不良反应发生率比较差异无显著性（P>0.05）。结论：相比单用利培酮,利培酮+奥氮平应用于首发精神分裂症伴肥胖患者,可明显改善其认知功能,但对糖脂代谢的不利影响可能更大,应加以监测,而2种治疗方案对相关激素水平改善效果相似。     

Predictors of antipsychotic-induced weight gain in first-episode psychosis: conclusions from a randomized, double-blind, controlled prospective study of olanzapine, risperidone, and haloperidol

BACKGROUND: Antipsychotic-induced weight gain is one of the most distressing adverse effects being observed in recent times. Most studies have been limited by several confounders. AIM: To evaluate the predictors of antipsychotic-induced weight gain in drug-naive patients with first-episode psychosis treated with olanzapine, risperidone, or haloperidol and compare them with a healthy matched control group. METHODS: Newly diagnosed patients with first-episode schizophrenia treated with antipsychotic medication-olanzapine, risperidone, or haloperidol-and matched healthy controls were followed for 6 weeks. Body mass index (BMI), waist circumference, and weight changes and proportions of subjects with more than 7% weight gain were calculated. The predictors of weight gain were explored. RESULTS: Ninety-nine patients with first-episode schizophrenia and 51 healthy controls were examined. Waist circumference (r = -0.25; P < 0.01) and weight (r = -0.24; P < 0.01) at baseline in addition to the disease process (P < 0.001) as well as antipsychotic use (P < 0.001) were associated with greater increases in weight and BMI. Olanzapine (77%) had greater clinically significant weight gain as compared with risperidone (63%) and haloperidol (22%). Lower BMI at baseline and a diagnosis of undifferentiated schizophrenia were associated with antipsychotic-induced weight gain. CONCLUSIONS: The results confirm clinically significant and substantial weight gain induced by antipsychotic treatment in drug-naive patients with first-episode schizophrenia and identify several risk factors for weight gain such as lower BMI scores, use of olanzapine, and a diagnosis of undifferentiated schizophrenia.     

Differential effects of olanzapine and risperidone on plasma adiponectin levels over time: Results from a 3-month prospective open-label study

Second-generation antipsychotics (SGA), especially clozapine and olanzapine, are associated with an increased metabolic risk. Recent research showed that plasma adiponectin levels, an adipocyte-derived hormone that increases insulin sensitivity, vary in the same way in schizophrenic patients as in the general population according to gender, adiposity and metabolic syndrome (MetS). The aim of the present study was to investigate whether different SGAs differentially affect plasma adiponectin levels independent of body mass index (BMI) and MetS status.113 patients with schizophrenia (65.5% males, 32.3 years old) who were free of antipsychotic medication were enrolled in this open-label prospective single-center study and received either risperidone (n = 54) or olanzapine (n = 59). They were followed prospectively for 12 weeks. Average daily dose was 4.4 mg/day for risperidone and 17.4 mg/day for olanzapine. Plasma adiponectin levels as well as fasting metabolic parameters were measured at baseline, 6 weeks and 12 weeks.The two groups had similar baseline demographic and metabolic characteristics. A significant increase in body weight was observed over time. This increase was significantly larger in the olanzapine group than in the risperidone group (+ 7.0 kg versus + 3.1 kg, p < 0.0002). Changes in fasting glucose and insulin levels and in HOMA-IR, an index of insulin resistance, were not significantly different in both treatment groups. MetS prevalence increased significantly more in the olanzapine group as compared to the risperidone groups where the prevalence did not change over time. We observed a significant (p = 0.0015) treatment by time interaction showing an adiponectin increase in the risperidone-treated patients (from 10,154 to 11,124 ng/ml) whereas adiponectin levels decreased in olanzapine treated patients (from 11,280 to 8988 ng/ml). This effect was independent of BMI and the presence/absence of MetS.The differential effect of antipsychotic treatment (risperidone versus olanzapine) on plasma adiponectin levels over time, independent of changes in waist circumference and antipsychotic dosing, suggests a specific effect on adipose tissues, similar to what has been observed in animal models. The observed olanzapine-associated reduction in plasma adiponectin levels may at least partially contribute to the increased metabolic risk of olanzapine compared to risperidone.     

奥氮平与奋乃静对老年精神分裂症患者的体重、血糖及血脂影响的对照研究

目的 探讨奥氮平与奋乃静对老年精神分裂症患者的体重、血糖及血脂等的影响.方法 对68例住院的老年精神分裂症患者,随机分成奥氮平与奋乃静治疗组,在12周的治疗的不同时期观察体重、体重指数、腹围、血糖及血脂的变化,同时对两组之间进行以上数据的比较研究.结果 奥氮平与奋乃静组都会引起相应的体重、体重指数和腹围及部分血脂值的增加,而奥氮平组的体重及体重指数增加更加明显,奥氮平与奋乃静在对老年精神分裂症患者的腹围、血糖、血脂等方面的影响没有明显的区别.结论 非经典抗精神病药物奥氮平与经典抗精神病药物奋乃静都会引起老年精神分裂症患者部分代谢指标的变化,非经典药物对体重等的影响要引起重视.     

A crossover study on lipid and weight changes associated with olanzapine and risperidone

Rationale The results from case–control and retrospective studies revealed that olanzapine might be associated with more increased risks of metabolic dysfunction than risperidone. The crossover design can minimize the influence of individual variation in metabolic profiles and demographic variables, such as age, sex, concomitant medication use and personal life styles.Objectives We design a crossover study to evaluate the metabolic effect of olanzapine and risperidone.Methods Fifteen schizophrenic patients were shifted from olanzapine and risperidone or from risperidone and olanzapine due to poor treatment response. The body weights, lipid profiles and fasting glucose levels were assessed before medication switch and 3 months after crossover.Results In the seven patients taking risperidone at the time of inclusion (risperidone-first group), after shifting to olanzapine, there was a significant increase in triglyceride level (p=0.048) and body weight (p=0.008). In the other eight patients (olanzapine-first group), after shift to risperidone, there was a decrease in triglyceride level (p=0.009), body weight (p=0.049) and body mass index (BMI; p=0.04). When comparing the metabolic profiles in all patients after olanzapine and after risperidone (irrespective of the order of treatment), the mean triglyceride level (p=0.001), body weight (p=0.001) and BMI (p=0.015) were significantly higher in patients receiving olanzapine than in those receiving risperidone. Furthermore, there was a small increase in total cholesterol level (p=0.091) and a small decrease in high-density lipoprotein (HDL) level (p=0.061) in olanzapine group, but the differences did not reach a significant level. There was no significant difference between olanzapine and risperidone in fasting glucose and low-density lipoprotein (LDL).Conclusions This study confirms that elevated levels of triglyceride and body weight could be associated with the use of olanzapine as compared with risperidone. The changes in body weights and lipid profiles should be closely monitored in patients during treatment with atypical antipsychotic drugs.     

Effects of typical and atypical antipsychotics on glucose–insulin homeostasis and lipid metabolism in first-episode schizophrenia

Rationale Glucose and lipid metabolism dysfunction is a significant side effect associated with antipsychotics. Although there are many studies about the linkages between drugs and metabolic dysfunction, most of these studies have compared the effects of two antipsychotics on only one metabolic measure: either glucose or lipid metabolism.Objectives The present study aimed to investigate the effects of clozapine, olanzapine, risperidone, and sulpiride on glucose and lipid metabolism in first-episode schizophrenia.Materials and methods One hundred twelve schizophrenics were assigned randomly to receive clozapine, olanzapine, risperidone, or sulpiride for 8 weeks. Planned assessments included body mass index (BMI), waist-to-hip ratio, fasting glucose, insulin, C-peptide, insulin resistance index (IRI), cholesterol, and triglyceride. All measures were collected at baseline and at the end of the 8-week treatment.Results After treatment, insulin, C-peptide, and IRI were significantly increased in the four groups, but not fasting glucose levels. Cholesterol and triglyceride levels were significantly increased in the clozapine and olanzapine groups. Patients treated with clozapine and olanzapine had higher fasting insulin, C-peptide, and IRI levels than those treated with risperidone and sulpiride. Among the four antipsychotics, the increases of mean BMI from high to low were as follows: clozapine, olanzapine, sulpiride, and risperidone.Conclusions This study confirmed that the four antipsychotic drugs were associated with an increase of insulin, C-peptide, and IRI. It was found that clozapine and olanzapine were associated with an increase in cholesterol and triglyceride levels. The effects of clozapine and olanzapine on the glucose and lipid metabolism outweighed those of risperidone and sulpiride.     

Olanzapine: an updated review of its use in the management of schizophrenia

Olanzapine, a thienobenzodiazepine derivative, is a second generation (atypical) antipsychotic agent which has proven efficacy against the positive and negative symptoms of schizophrenia. Compared with conventional antipsychotics, it has greater affinity for serotonin 5-HT2A than for dopamine D2 receptors. In large, well controlled trials in patients with schizophrenia or related psychoses, olanzapine 5 to 20 mg/day was significantly superior to haloperidol 5 to 20 mg/day in overall improvements in psychopathology rating scales and in the treatment of depressive and negative symptoms, and was comparable in effects on positive psychotic symptoms. The 1-year risk of relapse (rehospitalisation) was significantly lower with olanzapine than with haloperidol treatment. In the first double-blind comparative study (28-week) of olanzapine and risperidone, olanzapine 10 to 20 mg/day proved to be significantly more effective than risperidone 4 to 12 mg/day in the treatment of negative and depressive symptoms but not on overall psychopathology symptoms. In contrast, preliminary results from an 8-week controlled study suggested risperidone 2 to 6 mg/day was superior to olanzapine 5 to 20 mg/day against positive and anxiety/depressive symptoms (p < 0.05), although consistent with the first study, both agents demonstrated similar efficacy on measures of overall psychopathology. Improvements in general cognitive function seen with olanzapine treatment in a 1-year controlled study of patients with early-phase schizophrenia, were significantly greater than changes seen with either risperidone or haloperidol. However, preliminary results from an 8-week trial showed comparable cognitive enhancing effects of olanzapine and risperidone treatment in patients with schizophrenia or schizoaffective disorder. Several studies indicate that olanzapine has benefits against symptoms of aggression and agitation, while other studies strongly support the effectiveness of olanzapine in the treatment of depressive symptomatology. Olanzapine is associated with significantly fewer extrapyramidal symptoms than haloperidol and risperidone. In addition, olanzapine is not associated with a risk of agranulocytosis as seen with clozapine or clinically significant hyperprolactinaemia as seen with risperidone or prolongation of the QT interval. The most common adverse effects reported with olanzapine are bodyweight gain, somnolence, dizziness, anticholinergic effects (constipation and dry mouth) and transient asymptomatic liver enzyme elevations. In comparison with haloperidol, the adverse events reported significantly more frequently with olanzapine in > or = 3.5% of patients were dry mouth, bodyweight gain and increased appetite and compared with risperidone, only bodyweight gain occurred significantly more frequently with olanzapine. The high acquisition cost of olanzapine is offset by reductions in other treatment costs (inpatient and/or outpatient services) of schizophrenia. Pharmacoeconomic analyses indicate that olanzapine does not significantly increase, and may even decrease, the overall direct treatment costs of schizophrenia, compared with haloperidol. Compared with risperidone, olanzapine has also been reported to decrease overall treatment costs, despite the several-fold higher daily acquisition cost of the drug. Olanzapine treatment improves quality of life in patients with schizophrenia and related psychoses to a greater extent than haloperidol, and to broadly the same extent as risperidone. CONCLUSIONS: Olanzapine demonstrated superior antipsychotic efficacy compared with haloperidol in the treatment of acute phase schizophrenia, and in the treatment of some patients with first-episode or treatment-resistant schizophrenia. The reduced risk of adverse events and therapeutic superiority compared with haloperidol and risperidone in the treatment of negative and depressive symptoms support the choice of olanzapine as a first-line option in the management of schizophrenia in the acute phase and for the maintenance of treatment response.     

Metabolic effects of olanzapine in patients with newly diagnosed psychosis

Antipsychotic medications are associated with an increased risk of diabetes. Previous studies have also found an increased risk of type 2 diabetes mellitus in the relatives of schizophrenia probands. The aim of this study was to explore the metabolic adverse effects of olanzapine in a cohort of patients with newly diagnosed psychosis and minimal or no exposure to antipsychotics. Patients with newly diagnosed psychosis (n = 30) were enrolled in a 16-week open trial of olanzapine. Body mass index, fasting glucose, hemoglobin A1c, fasting insulin, IL-6, and a fasting lipid profile were measured at baseline and at 4-week intervals. There was a significant, linear increase over time in fasting glucose (P = 0.043), weight (P < 0.001), body mass index (P < 0.001), total cholesterol (P = 0.005), triglycerides (P = 0.003), and low-density lipoprotein (P = 0.013), but not hemoglobin A1c (P = 0.691), fasting insulin (P = 0.690), IL-6 (P = 0.877), or high-density lipoprotein (P = 0.446). An abnormal baseline IL-6 was a significant predictor of a greater increase in both total cholesterol (P < 0.01) and low-density lipoprotein (P < 0.01). Otherwise, neither parental history of type 2 diabetes mellitus nor baseline IL-6 predicted changes in metabolic measures. Changes in metabolic measures with olanzapine treatment can be detected early in the treatment of patients who are previously antipsychotic naive. The absence of a change in fasting insulin suggests a failure of pancreatic islet cells to compensate for the increase in fasting glucose.     

Comparison of the metabolic effects observed in patients treated with ziprasidone versus olanzapine

This study aimed to examine the impact of ziprasidone and olanzapine on QTc interval, weight and metabolic parameters in adults with schizophrenia and other psychoses. A retrospective cohort chart review was performed of 191 randomly selected patients who were being treated with ziprasidone or olanzapine in an integrated health care system. Significant differences on QTc interval were not observed. A significant weight gain was observed in olanzapine-treated patients (P<0.001) but not in the ziprasidone-treated cohort (P>0.05). Furthermore, adverse metabolic changes associated with olanzapine administration were significant with respect to effects on total cholesterol (P=0.01), triglycerides (P=0.05) and haemoglobin A1C (HbA1C) (P<0.05), whereas significant favourable metabolic effects were observed in ziprasidone-treated patients with regard to total cholesterol (P<0.05), low-density lipoprotein (LDL) (P<0.01), high-density lipoprotein (HDL) (P<0.05) and HbA1c (P<0.05). Our results suggest that these two atypical antipsychotics are safe and well tolerated from a cardiovascular standpoint, with no differences in QTc interval prolongation being observed. Olanzapine-treated patients exhibited significant weight increases, whereas ziprasidone-treated patients exhibited weight loss. Olanzapine treatment was also associated with significant adverse effect on patient's lipid profile and HbA1c. These adverse metabolic effects were not observed in ziprasidone-treated patients although favourable effects were observed with regard to effect on total cholesterol, LDL, HDL and HbA1c.     

服用奥氮平、利培酮精神分裂症患者的心电图分析

目的：了解服用奥氮平、利培酮治疗精神分裂症患者心电图变化情况。方法随机对服用奥氮平160例,利培酮60例精神分裂症患者心电图进行分析。结果奥氮平组心电图表现正常65例（40.63％）,心电图异常95例（59.37％）。利培酮组心电图表现正常22例（36.67％）心电图异常38例（63.33％）,两药均可引起心电图改变。主要窦性心动过速,过缓,心律不齐,ST-T改变,T波异常,Q-T间期延长,短P-R间期,U波改变。二者无明显差异（P＞0.05）。随着用药时间和剂量的增加两药的心电图异常率亦增加。结论奥氮平与利培酮都会影响心电图改变,特别在药物增加和大剂量长期应用患者应复查心电图。     

Cardiovascular variability during treatment with haloperidol, olanzapine or risperidone in recent-onset schizophrenia

This study aimed to investigate the effects of treatment with haloperidol, olanzapine and risperidone on cardiovascular variability in patients with recent-onset schizophrenia by means of spectral analysis. Unmedicated patients (n = 18) had a higher mean heart rate and a tendency for a lower high-frequency power of heart rate variability than healthy control subjects (n = 57), indicating a decreased cardiac vagal control in unmedicated patients with schizophrenia. Patients treated with haloperidol (n = 10) showed significantly lower low-frequency power of heart rate and systolic blood pressure variability compared with olanzapine-treated patients, suggesting that haloperidol attenuated sympathetic functioning. On the contrary, olanzapine-treated patients (n = 10) showed the highest power in the low-frequency range of heart rate and systolic blood pressure variability, suggesting an increased sympathetic cardiac functioning. No significant effects of risperidone (n = 13) were found. None of the antipsychotic agents differed in their parasympathetic cardiovascular effects. We conclude that young, unmedicated patients with schizophrenia differed from controls in their parasympathetic functioning, but the antipsychotic agents haloperidol, risperidone and olanzapine induced only minor cardiovascular side effects.     

Long-term changes in weight and plasma lipids during maintenance treatment with ziprasidone.

To measure the long-term changes in weight and plasma lipids after switching antipsychotic treatment to ziprasidone, three 52-week, open-label extension studies of ziprasidone in outpatients (N=185) with schizophrenia or schizoaffective disorder successfully completing one of three, 6-week switch studies were carried out. Pre-switch treatment consisted of risperidone (n=43), olanzapine (n=71), or conventional antipsychotic agents (n=71). The maximum length of exposure to ziprasidone was 58 weeks. Nonfasting total cholesterol and triglyceride levels were obtained at baseline and at weeks 6, 19, 32, 45, and 58. Weight was measured at baseline and during each follow-up visit; height was recorded at baseline for the purpose of body mass index (BMI) calculation. Efficacy measures included the Positive and Negative Syndrome Scale and Clinical Global Impression-Severity scale which were obtained at baseline and major follow-up points. Clinically significant sustained improvements in weight, BMI, total cholesterol, and triglyceride levels were observed among patients switched to ziprasidone from risperidone or olanzapine. Switching from conventional antipsychotics was not associated with significant changes in weight and lipid parameters. Mean reductions in weight from baseline to study endpoint were 9.8 kg (p<0.001) and 6.9 kg (p<0.005) for patients previously treated with olanzapine and risperidone, respectively. These findings demonstrate that switching from risperidone or olanzapine to ziprasidone is associated with sustained, clinically significant improvements in weight and plasma lipids.     

Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): efficacy and tolerability results of an international naturalistic study.

The Risperidone Olanzapine Drug Outcomes studies in Schizophrenia (RODOS) programme was an international series of naturalistic studies designed to evaluate drug use patterns and outcomes. RODOS consisted of retrospective chart reviews performed in patients who had been admitted to hospital and treated in 61 centres in nine countries. The analysed population consisted of 1901 patients with diagnoses of schizophrenia or schizoaffective disorder. The mean (SD) daily doses of risperidone and olanzapine were 5.3 (2.6) mg/day and 14.5 (5.1) mg/day, respectively. Patients treated with risperidone stayed an average of 3.8 days less in hospital compared to those receiving olanzapine (time to discharge was 43.6 days versus 47.4 days, respectively; P = 0.004). Risperidone was rated as effective in significantly more patients than olanzapine (84% versus 79%; P = 0.01). The time to onset of efficacy was significantly shorter with risperidone than with olanzapine (P < 0.001). The numbers of adverse events in the two treatment groups were not significantly different (13% risperidone, 11% olanzapine; P = 0.1). Correcting for small but statistically significant baseline differences between the two treatment groups did not produce a substantive change in the magnitude or significance of any outcome parameter. In conclusion, the clinical outcomes reported by RODOS suggest that risperidone may be more effective as a first-line therapy drug for schizophrenia than olanzapine.     

帕利哌酮缓释片与利培酮片对女性首发精神分裂症患者糖脂代谢影响的对比研究

目的 观察对比帕利哌酮缓释片与利培酮片对女性首发精神分裂症患者糖脂代谢影响。方法 将85例在德阳市精神卫生中心治疗的女性首发精神分裂症患者随机分为观察组42例和对照组43例，分别给予帕利哌酮缓释片和利培酮片单药治疗2个月。治疗前后测量体质量指数（BMI）、腰围、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDLC）、低密度脂蛋白（LDLC）、空腹血糖（FPG）、餐后2 h血糖（2 h PG），采用阳性和阴性症状量表（PANSS）进行疗效评价。结果 治疗前两组PANSS总分及各因子分（阳性症状、阴性症状和精神病性分）及治疗后两组PANSS总分及各因子分分别比较，差异均无统计学意义。与治疗前相比，治疗后两组PANSS总分[观察组（47.94±13.64）分，对照组（49.07±12.56）分]及各因子分均显著低于治疗前PANSS总分[观察组（86.31±9.21）分，对照组（85.95±9.77）分]及各因子分，差异具有统计学意义（P<0.05）。治疗前两组患者糖、脂各指标比较，差异无统计学意义。治疗后对照组TG、TC、LDLC、BMI和腰围上升，HDLC降低，与治疗前比较，差异具有统计学意义（P<0.05）；观察组BMI和腰围与治疗前比较明显变大，差异具有统计学意义（P<0.05）。观察组治疗后TG、TC、LDLC、BMI和腰围均显著低于对照组，HDLC显著高于对照组，差异具有统计学意义（P<0.05）。两组FPG、2hPG、SBP和DBP比较，差异无统计学意义。观察组患者不良反应发生率明显低于对照组（P<0.05）。结论 帕利哌酮缓释片和利培酮对女性首发精神分裂症患者具有相同的疗效，但是帕利哌酮缓释片对女性患者血脂、BMI和腰围的影响较小，要优于利培酮片。     

奥氮平与利培酮治疗老年精神分裂症的对照研究

目的：探讨国产奥氮平治疗老年精神分裂症的疗效和安全性。方法：将64例符合中国精神障碍分类与诊断标准第3版（CCMD-3）的老年精神分裂症患者随机分成两组,分别给予奥氮平（治疗组,32例）和利培酮（对照组,32例）治疗,疗程8周。采用阳性与阴性综合征量表（PANSS）及副反应量表（TESS）评定疗效和不良反应。结果：奥氮平组显效率68.8%、有效率87.5%,利培酮组分别为65.6%、84.4%。两组间显效率（χ2=0.07、P〉0.05）及有效率（χ2=0.13,P〉0.05）的差异均无统计学意义。两组治疗后各时点PANSS总分,阳性症状、阴性症状和一般病理症状各项分值均低于治疗前,而治疗后各时点组间差异无统计学意义（P〉0.05）。不良反应方面：奥氮平组体重增加比例高于利培酮组;利培酮锥体外系不良反应高于奥氮平组,两组差异均有统计学意义（χ2=4.01,P〈0.05;χ2=4.27,P〈0.05）。结论：国产奥氮平与利培酮治疗老年精神分裂症疗效均好,奥氮平组体重增加较多,利培酮组锥体外系不良反应较多。