第2代抗精神病药对代谢的影响

目的：探讨奥氮平、奎硫平和齐拉西酮对首发精神分裂症患者血脂和体质量的影响。方法：选择件院治疗的首发精神分裂症患者114例．随机分为奥氮平组35例、奎硫平组41例、齐拉西酮组38例治疗前、治疗4周和治疗8周检测血脂水平和体质量。结果：奥氮平组治疗4周、治疗8周总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;高密度脂蛋白胆固醇（HDL）水平垃著降低（P〈0．05）;奎硫平组至治疗8周时,TC、TG、低密度脂蛋白胆固醇（LDL）和体质量均较治疗前显著升高（P〈0．05）;而齐拉西酮组治疗4周和治疗8周与治疗前比较,TC、TG、HDL、LDL、体质量水平差异均无显著性。在治疗8周奥氮平组、奎硫平组TC、TG、HDL、LDL、体质餐变化与齐拉西酮组比较差异有显著性（P〈0．05）。结论：齐拉西酮对精神分裂症患者血脂和体质量的影响较奥氮平、奎硫平小,奥氮平和奎硫平在精神分裂症治疗过程中均可导致血脂异常和体质量增加。     

氯丙嗪与奎硫平对血脂和血糖的影响

目的:研究氯丙嗪与奎硫平对精神分裂症患者血脂与血糖的影响。方法:130例精神分裂症患者随机分为氯丙嗪组(65例)与奎硫平组(65例),治疗8周。所有患者于治疗前与治疗4、8周测空腹血糖、总胆固醇、三酰甘油和体质量(体重)。结果:氯丙嗪组总胆固醇、三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01);奎硫平组三酰甘油、体质量在治疗第4、8周均较治疗前显著升高(P<0.01)。治疗8周后,两组男性患者总胆固醇与空腹血糖较治疗前均显著升高(P<0.01),女性患者三酰甘油与总胆固醇治疗后较治疗前显著升高(P<0.01)。结论:氯丙嗪与奎硫平对血脂和血糖的影响不同,2药对血脂与血糖的影响存在性别差异。     

奥氮平联合金刚烷胺治疗精神分裂症首次发病患者的随机双盲对照研究

目的:探讨金刚烷胺添加对奥氮平治疗精神分裂症首次发病患者疗效及脂代谢的影响。方法:采用随机双盲法,将61例精神分裂症首次发病的患者随机分为研究组(31例)和对照组(30例),在奥氮平治疗的基础上,研究组及对照组分别添加金刚烷胺200 mg/d及安慰剂;疗程8周。治疗前及治疗4、8周进行阳性和阴性症状量表(PANSS)及治疗过程中出现的症状量表(TESS)评定,测量体质量,检测血三酰甘油(TG)、低密度脂蛋白(LDL)、总胆固醇(TC)水平。结果:治疗后研究组PANSS阴性症状减分值显著大于对照组(P0.05);TESS评分两组间差异无统计学意义;两组体质量和TG增加值差异无统计学意义;对照组LDL、TC增加值显著大于研究组(P均0.05)。结论:添加小剂量金刚烷胺短期内可明显增加奥氮平对精神分裂症患者阴性症状的改善作用,减少血LDL和TC水平升高;但不能改善奥氮平所致的体质量增加。     

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。     

帕利哌酮和奥氮平对精神分裂症患者阳性症状、血脂、体质量的影响

目的对比帕利哌酮与奥氮平对精神分裂症患者阳性症状、血脂、体质量的影响。方法将70例精神分裂症患者随机分为帕利哌酮组和奥氮平组各35例。分别使用帕利哌酮缓释剂和奥氮平治疗,疗程均为8周。2组均采用阳性与阴性症状量表(PANSS)评定疗效,同时对比血脂、体质量的影响,评定不良反应。结果 2组疗效均显著,组间比较差异无统计学意义(P>0.05);帕利哌酮缓释剂组在导致体质量增加的不良反应明显低于奥氮平组(P<0.05),在对血脂的影响方面2组比较无统计学意义(P>0.05)。结论帕利哌酮可作为精神分裂症的一线用药和维持治疗用药,疗效可靠,导致体质量增加的不良反应少于奥氮平。     

奥氮平对精神分裂症患者执行功能障碍的影响

目的:探讨奥氮平对精神分裂症患者执行功能障碍的长期疗效。方法:对29例服用奥氮平维持治疗与24例服用氯丙嗪维持治疗的精神分裂症患者进行2年随访,采用威斯康星卡片分类测验(WCST)评估执行功能。结果:维持治疗2年末奥氮平组和氯丙嗪组的WCST测验中的总测验次数、持续错误数、随机错误数均显著下降(P<0.05或P<0.01),但奥氮平组的总测验次数、持续错误数、随机错误数减分率均显著高于氯丙嗪组(P均<0.01)。结论:奥氮平长期维持治疗能显著改善精神分裂症患者的执行功能。     

奥氮平、喹硫平或阿立哌唑治疗8周对首发精神分裂症患者血糖和血脂影响的前瞻性研究(英文)

背景:抗精神病药物引起代谢症状已广为报道,但很少有研究比较常用非典型抗精神病药物对首发精神分裂症患者血糖和血脂影响。方法:共150例首发精神分裂症患者,被随机分为三组,分别使用奥氮平、喹硫平或阿立哌唑治疗8周。在基线和8周治疗结束时测定血糖和血脂(包括三酰甘油、总胆固醇、低密度脂蛋白及高密度脂蛋白水平)水平。结果:治疗8周后奥氮平组空腹血糖显著升高,但是喹硫平组和阿立哌唑组空腹血糖均无明显升高。基于重复测量方差分析,经过8周治疗,三酰甘油水平显著升高而高密度脂蛋白水平显著降低。奥氮平组和喹硫平组两组的三酰甘油的升高程度以及高密度脂蛋白的下降程度均比阿立哌唑组明显。结论:精神分裂症患者初次使用药物治疗的前8周,奥氮平对血糖水平的影响大于喹硫平或阿立哌唑,而对血脂水平的影响则是奥氮平和喹硫平大于阿立哌唑。     

奥氮平对精神分裂症患者血脂、体质量的影响研究

目的探讨奥氮平对精神分裂症患者脂质代谢及体质量影响。方法采用自身对照方法，比较30例精神分裂症患者在奥氮平治疗第0、4、8、52周末的血脂水平及体质量变化。结果52周观察中，TC在第8周时达到高峰（p〈0.05）；TG在第52周时达到高峰，（p〈0．05）。HDL在第8周时达到低谷（p〈0．05）；LDL在整个52周各时间段中变化不明显（（p〉0．05））；体质量在第4～8周增长最快（p〈0．01），体质量的增长呈连续增长，第8周与52周比较无统计学意义，但标准差增大。从时间而言，第4周至8周与第8周至52周比较，血脂上升的速度前者较快（p〈0．05）。结论体质量增加以0～8周为重，高血脂症可能使血液流变学产生改变，HDL降低不能排除其它因素所致，LDL变化不明显，难以充分说明本药能导致粥样动脉硬化疾病。     

奥氮平与阿立哌唑对精神分裂症患者体质量、血浆神经肽Y及瘦素影响的比较

目的:比较奥氮平和阿立哌唑对精神分裂症患者体质量、血浆神经肽Y及瘦素水平的影响。方法:60例精神分裂症患者随机分为奥氮平组和阿立哌唑组各30例分别治疗8周。在治疗前、治疗后4周和8周测定两组体质量、血浆神经肽Y和瘦素水平并进行治疗前后比较。结果:奥氮平组在治疗4周和8周时体质量(F=287.207,F=506.777)、血浆神经肽Y水平(F=725.697,F=5152.624)明显高于治疗前(P均=0.000);瘦素水平治疗4周时与治疗前差异无统计学意义(F=3.908,P=0.058),治疗8周时高于治疗前(F=1589.726,P=0.000)。阿立哌唑组治疗4周和8周时体质量(F=2.810,F=1.819)、血浆神经肽Y(F=0.232,F=0.376)及瘦素水平(F=0.975,F=1.295)与治疗前比较差异无统计学意义(均P0.05)。奥氮平组治疗4周和8周时体质量的变化与神经肽Y的变化明显正相关(r=0.632,r=0.576;均P0.001),与瘦素的变化无相关(r=0.254,r=0.085;P均0.05)。逐步回归分析显示,奥氮平组神经肽Y变化进入以体质量变化为因变量的回归方程,治疗4周和8周时,神经肽Y变化可以解释体质量变化变异的40.0%和33.1%。结论:与阿立哌唑相比,奥氮平能显著增加精神分裂症患者体质量;血浆神经肽Y水平的变化可能是体质量增加的原因之一。     

奥氮平、辛伐他汀联合用药对精神分裂症患者脂质代谢的影响

目的探讨奥氮平联合辛伐他汀治疗对患者的临床效果及脂质代谢的影响。方法选取2012年1月~2015年6月在本院精神科治疗的48例精神分裂症患者采用抽签法进行随机分组,其中观察组(奥氮平+辛伐他汀)和对照组(奥氮平)各24例,疗程8周。结果治疗前、治疗2周、4周、8周,两组患者的PANSS评分差异无统计学意义(P0.05),治疗2周、4周、8周,两组患者的PANSS评分均呈逐渐降低的趋势(P0.05);治疗前,两组患者的TG、TC、HDL-C、LDL-C、FPG、Fins、BMI差异无统计学意义(P0.05),治疗8周后,观察组患者的TG、TC、LDL-C、FPG、Fins均显著低于对照组(P0.05);治疗后,对照组患者的TG、TC、LDL-C、FPG、Fins较治疗前显著提高(P0.05)。结论奥氮平联合辛伐他汀治疗精神分裂症患者不会影响治疗效果,同时能够有效减轻奥氮平治疗过程中引起的血脂、血糖代谢紊乱。     

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     

四种非典型抗精神病药对血清催乳素和血脂的影响

目的探讨四种非典型抗精神病药对精神分裂症患者血脂和血清催乳素（PRL）的影响,以及血清PRL水平与药物疗效的关系。方法118例精神分裂症患者分为4组,分别予以喹硫平（29例）、氯氮平（30例）、奥氮平（30例）和利培酮（29例）治疗12周。于治疗前及治疗4、8及12周末予以阳性与阴性症状量表（PANSS）评定,测定血总胆固醇（TC）、甘油三脂（TG）高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、阿朴脂蛋白A—I（ApoA-1）、阿朴脂蛋白-B（Apo—B）及血清PRL浓度。结果（1）喹硫平组TG、HDL在12周末有显著升高（P〈0．05）,氯氮平组Apo—B在4、12周末有显著升高（P〈0．05）、LDL在8、12周末有显著升高（P〈0．05）,利培酮组除TG外其余血脂指标在8、12周末有显著升高（P〈0．05）,奥氮平组TG、HDL、LDL、ApoA-1、Apo—B在12周末有显著升高（P〈0．05）,TC在8与12周有显著升高（P〈0．05）。（2）利培酮组治疗8、12周后血清PRL明显升高（P〈0．01）。（3）氯氮平组和利培酮组PANSS一般病理分的减分率分别与PRL、LDL有显著相关;氯氮平组PRL与LDL有显著相关。结论利培酮、奥氮平、喹硫平和氯氮平均影响血脂代谢;氯氮平疗效与血清催乳素及LDL有关,利培酮疗效与LDL有关。     

Serum lipid profiles and schizophrenia: effects of conventional or atypical antipsychotic drugs in Taiwan

This study investigated the relationships between serum lipid profiles and schizophrenia and the effects of conventional or atypical antipsychotic drugs on serum lipid profiles. During a 1-year period, fasting blood samples for serum lipid profiles were collected from 126 schizophrenic patients and 59 healthy control subjects. The serum lipid profiles were detected by enzymatic determination. Patients were assessed for disease severity at baseline and endpoint at 3 weeks using the Positive and Negative Syndrome Scale. At baseline, patients with acute-phase schizophrenia had lower high-density lipoprotein (HDL) levels, higher low-density lipoprotein (LDL) levels, and higher ratios of total cholesterol/high-density lipoprotein (TC/HDL) and LDL/HDL than healthy control subjects. At endpoint, after a 3-week treatment with antipsychotics, the blood samples of the 97 schizophrenic patients were assessed again. Responders to antipsychotic treatment (n = 68) but not nonresponders (n = 29) had significantly increased TC, triglyceride (TG), and very low-density lipoprotein (VLDL) levels and decreased ratio of LDL/HDL. Experimental findings also showed significantly increased TC, TG, HDL, and VLDL levels and decreased ratio of LDL/HDL in responders taking atypical antipsychotic drugs (n = 32), but not in patients treated with conventional antipsychotic drugs (n = 36). In conclusion, this study identified strong associations between dyslipidemia and acute-phase schizophrenia and dyslipidemia and responders taking atypical antipsychotics; both associations would increase the risk of developing diabetes and coronary heart disease.     

A comparison of the efficacy and safety of olanzapine and risperidone in the treatment of elderly patients with schizophrenia: an open study of six months duration

BACKGROUND: Following an earlier study in which elderly patients with schizophrenia had their typical antipsychotic medication changed to olanzapine or risperidone, the 61 patients were followed for up to a further six months to see if either treatment was superior in terms of efficacy or side effects. AIMS: To determine whether either olanzapine or risperidone was superior in terms of efficacy or side effects when treating schizophrenia in late life. METHODS: Psychiatric symptoms, side effects and quality of life were rated every six weeks for 24 weeks of open label comparative treatment using standard measures. Group differences were examined using analysis of covariance and within-group changes over time were assessed using paired t-tests. RESULTS: There were 34 olanzapine and 32 risperidone patients who entered the study, but intention to treat data was only available for 61 of the 66 patients. There were no clinical or demographic differences between the groups. Parkinsonism, positive and negative symptoms of schizophrenia improved in both groups both from baseline switch to olanzapine or risperidone and during the six month follow-up after completion of crossover. No significant differences were seen between groups on most measures. However, patients treated with olanzapine showed a significantly greater improvement in quality of life from baseline compared to risperidone patients. CONCLUSIONS: Both drugs were well tolerated and their use was associated with fewer symptoms of schizophrenia and less adverse effects than were seen when the patients were taking a typical antipsychotic at baseline. Olanzapine appears to have particular benefit with regard to quality of life.     

Sleep propensity at daytime as assessed by Multiple Sleep Latency Tests (MSLT) in patients with schizophrenia increases with clozapine and olanzapine

Sleep propensity at daytime has not been investigated in untreated patients with schizophrenia. Furthermore, while the antipsychotics clozapine and olanzapine are considered to frequently cause 'sleepiness' or 'sedation', this has not been objectified yet. Therefore, 30 patients with schizophrenia were included in this randomized, double-blind study. Sleep propensity was assessed before and after 2, 4 and 6 weeks of treatment with either clozapine or olanzapine using a Multiple Sleep Latency Test (MSLT); in the MSLT, sleep latencies of 5 nap opportunities of 20 min during daytime are averaged. In addition, the number of sleep onsets was recorded. Mean sleep latency in untreated schizophrenic patients was 16.2 ± 0.8 min at baseline. Both antipsychotics induced an increase of sleep propensity as indicated by a shortened sleep latency and more sleep onsets during the treatment period as compared to baseline. These effects were strongest in the morning. Four patients receiving clozapine and 3 patients receiving olanzapine reported subjective sleepiness, in all but one commencing in the first treatment week and persisting until study end. While the mean sleep latency during treatment was significantly shorter in these patients (12.3 ± 0.8 min) than in those without subjective sleepiness (14.9 ± 0.7 min), a short sleep latency was not necessarily associated with subjective sleepiness. In conclusion, mean sleep latency was >36% longer (i.e. sleep propensity was lower) in untreated patients with schizophrenia than in healthy subjects previously consistently reported. Furthermore, clozapine and olanzapine increased sleep propensity in schizophrenic patients. A minority of patients reported subjective sleepiness.     

抗精神病药引起女性闭经的调查

目的了解女性患者服用抗精神病药后出现闭经的情况。方法对入院后的女性精神分裂症患者进行观察,对四种药物用药前及用药后四周血清泌乳素(PRL),和四种药物所致闭经的构成比做统计分析。结果2004年10月至2006年3月共观察女性病人408例,根据所服抗精神病药不同分成四组,四组患者服药后四周PRL明显升高。四种药物所致闭经的构成比如下:氯丙嗪(104例)27.88%;利培酮(118例)34.75%;奥氮平(96例)21.88%;奎硫平(90例)11.11%。结论抗精神病药所致闭经是常见副反应,在本次调查中,四种抗精神病药用药后四周PRL较用药前升高明显,在用药过程中出现闭经的比例均在10.00%以上,其中以氯丙嗪、利培酮为高。     

氯氮平对血清甲状腺素和血糖、血脂水平的影响

目的 探讨氯氮平对精神分裂症患者糖、脂代谢与血清甲状腺素水平的影响.方法 对60例接受氯氮平治疗的住院精神分裂症患者分别在治疗前和治疗8周末检测血糖（FPG）、胆固醇（TC）和甘油三脂（TG）及甲状腺相关激素水平.并对以上检测指标做统计分析.结果 氯氮平治疗8周后血清T4水平显著下降（P＜0.01）,TSH水平显著升高（P＜0.01）;血糖、甘油三脂显著升高（P＜0.01）;治疗8周末血糖分别与血清FT3、FT4、T3及T4水平呈显著负相关;甘油三脂与TSH水平呈显著正相关.结论 氯氮平导致糖、脂代谢紊乱和甲状腺功能改变,而糖、脂代谢紊乱与其血清甲状腺素水平变化有-定的相关性.