新型抗精神病药对躁狂发作的辅助治疗

目的:研究利培酮与奥氮平合并碳酸锂治疗双相障碍躁狂发作的疗效与安全性.方法:66例双相障碍躁狂发作患者随机分为两组,使用碳酸锂治疗,分别合用利培酮或奥氮平,疗程6周.以Bech-Rafaelsen躁狂量表(BRMS)、大体评定量表(GAS)、疗效总评量表病情严重程度(CGI-SI)、副反应量表(TESS)进行评价.结果:利培酮组与奥氮平组疗效相仿,不良反应有不同.结论:利培酮与奥氮平可作为治疗躁狂症的辅助药物.     

碳酸锂单用与合并阿立哌唑治疗双相障碍I型躁狂发作患者的随机对照研究

目的:探讨碳酸锂单用及合并阿立哌唑治疗双相障碍I型躁狂发作患者的疗效和安全性。方法:86例门诊双相障碍I型躁狂发作患者被随机分为联合组(碳酸锂+阿立哌唑治疗)和单药组(碳酸锂单药治疗),疗程8周。分别在治疗前、治疗2、4、8周进行杨氏躁狂量表(YMRS)和汉密顿抑郁量表(HAMD)-17项评定,采用治疗中出现的症状量表(TESS)评定不良反应。结果:治疗前两组YMRS评分差异无统计学意义;治疗2、4、8周后联合组YMRS减分值明显高于对照组(P0.05或P0.01);治疗前后两组HAMD均7分;两组TESS评分差异无统计学意义。结论:碳酸锂联合阿立哌唑治疗双相障碍I型躁狂发作较单用碳酸锂起效快,症状改善更明显,且未见不良反应明显增加。     

奥氮平与碳酸锂治疗躁狂发作的对照研究

目的：比较奥氮平与碳酸锂治疗双相Ⅰ型障碍急性躁狂发作的疗效及安全性。方法：57例符合美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）双相Ⅰ型障碍急性躁狂发作患者随机分为奥氮平组与碳酸锂组。治疗6周。以Bech-Rafaelsen躁狂量表（BRMS）、大体评定量表（GAS）、临床疗效总评量表（CGI）评估疗效,治疗中出现的症状量表（TESS）评定不良反应。结果：奥氮平与碳酸锂疗效相当（P〉0.05）,各有其不良反应。治疗前后TESS量表分,两组间差异无显著性（P〉0.05）。结论：奥氮平治疗双相Ⅰ型障碍急性躁狂发作,疗效和不良反应与碳酸锂无明显差异。     

奎硫平治疗双相情感障碍临床分析

目的：评价奎硫平单药治疗及联合碳酸锂治疗双相情感障碍躁狂发作的疗效和安全性。方法：78例双相情感障碍躁狂发作患者随机分成奎硫平单药治疗组（研究组）和奎硫平联合碳酸锂治疗组（对照组）各39例。观察4周。于治疗前以及治疗1、2和4周分别采用杨氏躁狂量表（YMRS）、阳性与阴性症状量表（PANSS）评价疗效;采用不良事件量表、SimpsonAngus量表、Barnes静坐不能评定量表及不自主运动量表评价药物安全性。结果：治疗4周,研究组痊愈率63.89%,有效率94.44%;对照组分别为66.67%和94.44%,两组比较,差异无统计学意义（P〉0.05）。两组YMRS评分治疗前差异无统计学意义（P〉0.05）,治疗后各周均有显著下降（P均〈0.01）;两组比较,差异无统计学意义（P〉0.05）。研究组不良反应总发生率显著低于对照组（χ2=4.06,P〈0.05）。结论：奎硫平单药治疗双相情感障碍躁狂发作与奎硫平联合碳酸锂治疗疗效相同,且单药治疗不良反应发生率更低。     

帕利哌酮联合心境稳定剂治疗双相障碍躁狂发作的疗效与安全性研究

目的研究帕利哌酮联合心境稳定剂治疗双相障碍躁狂发作的疗效与安全性。方法200例双相障碍躁狂发作患者分为碳酸锂、丙戊酸钠单药治疗组和帕利哌酮+碳酸锂、帕利哌酮+丙戊酸钠联合治疗组,治疗共6周。于治疗前及治疗后1、2、4、6周末采用临床总体印象量表-双相障碍版(CGI-BP)、Young躁狂量表(YMRS)和副反应量表(TESS)等评定疗效和安全性。结果四组YMRS和CGI-BP较治疗前均有下降(p0.05),联合治疗组下降水平要强于单药治疗组(p0.05),其中帕利哌酮联合丙戊酸钠组在1、2周末下降速度和水平要强于帕利哌酮联合碳酸锂组(p0.05);四组间不良反应发生率无明显差异(p0.05)。结论帕利哌酮缓释片联合碳酸锂或丙戊酸钠能快速有效控制双相障碍躁狂发作,耐受性好。     

碳酸锂联合奥氮平对双相躁狂患者外周血单核细胞糖原合成酶激酶3活性的影响

目的:探讨碳酸锂联合奥氮平治疗对双相躁狂发作患者外周血单核细胞(PBMCs)糖原合成酶激酶3(GSK3)活性的影响. 方法:21例双相Ⅰ型躁狂发作患者给予碳酸锂合并奥氮平治疗8周,于治疗前、治疗4周和8周采集患者外周静脉血20ml,应用免疫印迹法检测PBMCs的GSK3α和GSK3β丝氨酸磷酸化水平以及总GSK3水平...     

奥卡西平和碳酸锂治疗双相障碍躁狂发作患者的对照研究

目的：比较奥卡西平和碳酸锂治疗双相障碍躁狂发作的疗效和安全性。方法：70例双相障碍躁狂发作患者随机分为奥卡西平组和碳酸锂组各35例,分别给予奥卡西平和碳酸锂治疗8周。以Bech-Rafaelsen躁狂量表（BRMS）、临床疗效总评量表-病情严重程度（CGI-SI）以及治疗中出现的症状量表（TESS）评定疗效及不良反应。结果：两组治疗后BRMS、CGI-SI评分均较治疗前显著下降（P〈0.05或P〈0.01）;两组间比较差异无统计学意义（P〉0.05）;两组不良反应均为轻度。结论：奥卡西平治疗双相障碍躁狂发作的疗效与碳酸锂相当,不良反应轻。     

喹硫平（思瑞康）单药或联合锂盐治疗双相躁狂发作的疗效和安全性

目的 比较喹硫平单药或联合锂盐治疗双相躁狂患者的疗效和安全性.方法 24例患者随机给予喹硫平单药或联合锂盐治疗,于基线、治疗第1、2、3、4周末,分别采用临床总体印象量表一双相障碍版(CGI-BP)、Young躁狂量表(YMRS)、阳性和阴性症状量表(PANSS)评定疗效.基线和终点时进行生化、血常规、尿常规以及心电图检查,以评价安全性.结果 试验组和对照组的YMRS和PANSS的得分随着治疗时间而逐渐下降,每组各时间点之间存在统计学显著性(P<0.01),但是两组之间比较无统计学意义(P>0.05).两组在有效率、痊愈率和病情改善方面比较无统计学意义(P>0.05),两组均未出现严重的不良事件.结论 喹硫平(思瑞康)单药治疗双相障碍躁狂急性发作的疗效同联合碳酸锂治疗相当,但安全性高.     

奥氮平合并碳酸锂治疗躁狂发作临床对照研究

目的研究奥氮平合并碳酸锂与氟哌啶醇合并碳酸锂治疗躁狂发作的疗效及安全性。方法将72例躁狂发作患者随机分为两组,其中奥氮平组和氟哌啶醇组各36例,进行为期6周的对照研究,采用躁狂量表和不良反应症状量表评定疗效及安全性。结果奥氮平组与氟哌啶醇组疗效相当(P>0.05),而奥氮平组副作用明显少于氟哌啶醇组。结论奥氮平合并碳酸锂是治疗躁狂发作安全有效的药物。     

氟西汀与碳酸锂预防双相II型障碍重性抑郁发作复燃和转躁对照研究

目的:观察双相II型重性抑郁发作临床症状控制后较长期的单用氟西汀与单用碳酸锂治疗的复燃或转躁情况。方法:对75例双相II型障碍重性抑郁发作临床症状控制的患者随机分成两组,分别单用氟西汀与碳酸锂进行26周的治疗并随访,并进行汉密尔顿抑郁量表(HAMD)、杨氏躁狂量表(YMRS)评定。结果:治疗前1周、治疗2周、10周、18周、26周两组HAMD、YMRS评分两组同期比较差异均无显著性(P>0.05)。氟西汀组亚综合征抑郁和抑郁症复燃率低,碳酸锂组亚综合征轻躁狂和轻躁狂发作率低,两组比较差异均有显著性(P<0.05)。结论:双相II型障碍重性抑郁发作后氟西汀单一治疗比锂盐单一治疗可较好预防复燃,但能增加轻躁狂心境转换的发作。     

抗精神病药对躁狂症的治疗作用：利培酮治疗躁狂症对照观察

目的：了解利培酮对躁狂症患者的疗效及不良反应。方法：对90例躁狂症患者随机分为单用利培酮组30例,利培酮合并碳酸锂组30例及氯氮平合并碳酸锂组30例,在治疗前及治疗第1、2、4、6、8周末分别评定Young氏躁狂量表（YMRS）、阳性与阴性症状量表（PANSS）及治疗中出现的症状量表（TESS）,以了解疗效及不良反应。结果：单用利培酮组、利培酮合并碳酸锂组及氯氮平合并碳酸锂组治疗第2、4、6、8周末YMRS、PANSS总分均显著下降（P〈0.01）,但3组间比较差异无显著性（P〉0.05）。治疗第4、6、8周末TESS总分3组间比较差异有显著性（P〈0.01）。利培酮合并碳酸锂组及氯氮平合并碳酸锂组不良反应较单用利培酮组明显增多,尤其是氯氮平合并碳酸锂组更甚。结论：单用利培酮治疗躁狂症有效,而且不良反应更小。     

Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy.

BACKGROUND: A 6-week double-blind, randomized, placebo-controlled trial was conducted to determine the efficacy of combined therapy with olanzapine and either valproate or lithium compared with valproate or lithium alone in treating acute manic or mixed bipolar episodes. METHODS: The primary objective was to evaluate the efficacy of olanzapine (5-20 mg/d) vs placebo when added to ongoing mood-stabilizer therapy as measured by reductions in Young Mania Rating Scale (YMRS) scores. Patients with bipolar disorder (n = 344), manic or mixed episode, who were inadequately responsive to more than 2 weeks of lithium or valproate therapy, were randomized to receive cotherapy (olanzapine + mood-stabilizer) or monotherapy (placebo + mood-stabilizer). RESULTS: Olanzapine cotherapy improved patients' YMRS total scores significantly more than monotherapy (-13.11 vs -9.10; P = .003). Clinical response rates (> or = 50% improvement on YMRS) were significantly higher with cotherapy (67.7% vs 44.7%; P< .001). Olanzapine cotherapy improved 21-item Hamilton Depression Rating Scale (HAMD-21) total scores significantly more than monotherapy (4.98 vs 0.89 points; P< .001). In patients with mixed-episodes with moderate to severe depressive symptoms (DSM-IV mixed episode; HAMD-21 score of > or = 20 at baseline), olanzapine cotherapy improved HAMD-21 scores by 10.31 points compared with 1.57 for monotherapy (P< .001). Extrapyramidal symptoms (Simpson-Angus Scale, Barnes Akathisia Scale, Abnormal Involuntary Movement Scale) were not significantly changed from baseline to end point in either treatment group. Treatment-emergent symptoms that were significantly higher for the olanzapine cotherapy group included somnolence, dry mouth, weight gain, increased appetite, tremor, and slurred speech. CONCLUSION: Compared with the use of valproate or lithium alone, the addition of olanzapine provided superior efficacy in the treatment of manic and mixed bipolar episodes.     

Long-term olanzapine therapy in the treatment of bipolar I disorder: an open-label continuation phase study

BACKGROUND: Olanzapine has demonstrated efficacy in the treatment of acute mania in 2 double-blind, placebo-controlled trials. We describe the results of the open-label extension from one of these trials. METHOD: In a 3-week, double-blind study of patients with DSM-IV bipolar I disorder, olanzapine was superior to placebo for the treatment of acute manic symptoms. Of the 139 patients who entered the double-blind phase of the 3-week study, 113 patients continued into the 49-week open-label extension. Efficacy measurements including the Young Mania Rating Scale (YMRS), the 21-item Hamilton Rating Scale for Depression (HAM-D-21), the Clinical Global Impressions scale-Bipolar Version, and the Positive and Negative Syndrome Scale and safety measurements including the Simpson-Angus scale, the Barnes Akathisia Scale, and the Abnormal Involuntary Movement Scale were completed throughout. The analysis considered all treatment results, starting with the first olanzapine dose. Adjunctive lithium and fluoxetine were allowed during the open-label extension. RESULTS: The mean length of olanzapine treatment was 6.6 months, with a mean modal dose of 13.9 mg/day. A significant mean improvement in the YMRS total score, baseline to endpoint (-18.01, p < .001), was observed. During treatment, 88.3% of patients experienced a remission of manic symptoms (YMRS total score < or =12), and only 25.5% subsequently relapsed (YMRS total score > or = 15). Significant improvement in HAM-D-21 scores was observed (p < .001). Forty-one percent of patients were maintained on olanzapine monotherapy. The most common treatment-emergent adverse events reported were somnolence (46.0%), depression (38.9%), and weight gain (36.3%). CONCLUSION: During up to 1 year of olanzapine therapy, either as monotherapy or in combination with lithium and/or fluoxetine, patients with bipolar disorder demonstrated significant improvement in mania and depression symptoms with a favorable safety profile. Further double-blind, controlled studies are needed to confirm these results.     

奥氮平对老年抑郁症的增效作用

目的：探讨帕罗西汀联合小剂量奥氮平治疗老年抑郁症的疗效和安全性。方法：将96例老年抑郁症患者随机分为研究组和对照组,研究组采用帕罗西汀合并奥氮平治疗,对照组用帕罗西汀治疗,治疗12周。两组分别在治疗2、4、8、12周,采用汉密尔顿抑郁量表（HAMD）、临床疗效总评量表（CGI）评定疗效,用治疗中出现的症状量表（TESS）评定不良反应。结果：研究组HAMD评分降分率显著较大,CGI评分显著较低,两组TESS评分相仿。结论：帕罗西汀联合小剂量奥氮平治疗老年抑郁症的疗效好,不良反应无明显增加。     

奥氮平、氯氮平合并碳酸锂治疗躁狂症对照研究

目的 观察奥氮平、氯氮平分别合并碳酸锂治疗躁狂症的疗效和副反应。方法 将符合CCMD-3诊断标准的60例门诊或病房躁狂症患者随机分为两组，在使用碳酸锂的基础上分别合并奥氮平或氯氮平进行4周的治疗。使用躁狂量表（BRMS）及大体评定量表（GAS）、病情严重度量表（CGI-SI）评定疗效，使用副反应量表（TESS）评定副反应。结果 奥氮平组与氯氮平组疗效相当，总有效率分别为86．67％，83．33％，奥氮平组副反应显著低于氯氮平组。结论 奥氮平是一种治疗躁狂症安全有效的药物。     

A prospective open-label treatment trial of olanzapine monotherapy in children and adolescents with bipolar disorder

OBJECTIVE: The goal of this study was to assess the effectiveness and tolerability of olanzapine in the treatment of acute mania in children and adolescents. METHODS: This was an 8-week, open-label, prospective study of olanzapine monotherapy (dose range 2.5-20 mg/day) involving 23 bipolar youths (manic, mixed, or hypomanic; 5-14 years old). Weekly assessments were made using the Young Mania Rating Scale (YMRS), Clinical Global Impressions Severity Scale (CGI-S), Brief Psychiatric Rating Scale, and Children's Depression Rating Scale. Adverse events were assessed through self-reports, vital sign and weight monitoring, laboratory analytes, and extrapyramidal symptom rating scales (Barnes Akathisia Scale, Simpson-Angus Scale, and Abnormal Involuntary Movement Scale). RESULTS: Twenty-two of the 23 youths (96%) completed the study. Olanzapine treatment was associated with significant improvement in mean YMRS score (-19.0 +/- 9.2, p < 0.001). Using predefined criteria for improvement of > or = 30% decline in the YMRS and a CGI-S Mania score of < or = 3 at endpoint, the overall response rate was 61%. Overall, olanzapine was well tolerated, and extrapyramidal symptom measures were not significantly different from baseline. Body weight increased significantly over the study (5.0 +/- 2.3 kg, p < 0.001). CONCLUSIONS: Open-label olanzapine treatment was efficacious and well tolerated in the treatment of acute mania in youths with bipolar disorder. Future placebo-controlled, double-blind studies are warranted.