奥氮平、利培酮及阿立哌唑治疗慢性精神分裂症患者认知功能损害的疗效观察

目的：探讨奥氮平、利培酮及阿立哌唑治疗慢性精神分裂症患者认知功能损害的疗效观察。方法对93例慢性精神分裂症患者随机分为奥氮平组、利培酮组及阿立哌唑组各31例,分别给予奥氮平、利培酮及阿立哌唑进行治疗,比较3组患者认识功能。结果阿立哌唑组患者分类完成、言语流畅、记忆力及显性判断方面的表现明显优于其它2组（P ＜0．05）,3组患者持续错误的比较差异无显著性（P ＞0．05）;奥氮平组患者与利培酮组患者认知功能比较差异无显著性（P ＞0．05）。结论奥氮平、利培酮及阿立哌唑对精神分裂症患者分类完成、持续错误、言语流畅、记忆力及线性判断方面的作用不同,阿立哌唑对患者认知功能的改善更为显著。     

奥氮平与利培酮治疗首发精分症的对照研究

目的评价奥氮平与利培酮治疗首发精神分裂症的临床疗效及安全性。方法将符合入组标准的首发精神分裂症患者96例随机分为奥氮平组与利培酮组,分别治疗8周。采用阳性与阴性症状量表（PANSS）及副反应量表（TESS）评定疗效及副反应。结果奥氮平组与利培酮组的总有效率分别为91．67％和89．36％,差异无统计学意义（P〉0．05）;两组治疗前后PANSS评分比较差异均无统计学意义（P〉0．05）。两组治疗中的不良反应发生率低、程度轻,奥氮平组体重增加比例高于利培酮组,利培酮组锥体外系反应比例高于奥氮平组。结论奥氮平与利培酮治疗首发精神分裂症疗效相当,不良反应轻,但不良反应有异同。奥氮平组体重增加较多,利培酮组锥体外系反应发生较多。两种药物均为疗效好、安全性高的抗精神病药。     

A transcranial magnetic stimulation study of the effects of olanzapine and risperidone on motor cortical excitability in patients with schizophrenia

RATIONALE: There has been a progressive increase in interest in the functioning of the main inhibitory and excitatory neurotransmitters in the pathophysiology of schizophrenia. Limited information is available as to how these neurotransmitters are affected by commonly prescribed antipsychotic agents. OBJECTIVES: We investigated whether the atypical antipsychotics olanzapine and risperidone differ in their effects on inhibitory and excitatory cortical markers measured with transcranial magnetic stimulation. METHODS: Electromyographic recordings from the abductor pollicis brevis muscle were made during focal transcranial magnetic stimulation to the contralateral motor cortex and during bilateral cortical stimulation. Twenty patients on each drug and 22 controls were studied with measures of the resting motor threshold, motor evoked potential size, post-excitatory silent period duration, cortical inhibition and facilitation to paired-pulse transcranial magnetic stimulation and transcallosal inhibition. RESULTS: The patient groups differed from the controls in the silent period and transcallosal inhibition measures, both of which assess cortical inhibitory activity. The two medication groups differed in the magnitude of the resting motor threshold and several measures of transcallosal inhibition that reflect the spread of inhibitory activity between hemispheres. CONCLUSIONS: These findings suggest that olanzapine and risperidone differ subtly in their effects on cortical inhibitory mechanisms. Further evaluation is required to establish whether these differences may reflect or underlie differences seen between these medications in their clinical profiles, including their effects on cognitive symptoms of schizophrenia.     

Procedural learning in schizophrenia after 6 months of double-blind treatment with olanzapine,risperidone, and haloperidol

Rationale First generation antipsychotics induce extrapyramidal motor symptoms (EPS), presumably through dopamine D₂ receptor blockade at the dorsal striatum. This may also produce impairment of cognitive processes, such as procedural learning, that are dependent on this region. Haloperidol and, to a lesser extent, risperidone, are active in the dorsal striatum and may induce EPS and impairment of procedural learning. In contrast, the prototypical second-generation antipsychotic, clozapine, is less active in the dorsal striatum and does not induce EPS or impair procedural learning. Olanzapine is pharmacologically similar to clozapine and has a low incidence of EPS induction.Objectives To assess the hypothesis that olanzapine would not have a deleterious effect on procedural learning.Methods Thirty-nine subjects with early phase schizophrenia were randomly assigned to double blind treatment with haloperidol, risperidone, or olanzapine. They were administered the Tower of Toronto test at an unmedicated baseline and again following 6 weeks and 6 months of treatment.Results Procedural learning, defined as the improvement observed between two blocks of five trials of the Tower of Toronto, was preserved after 6 weeks of all three treatments but showed a substantial decline after 6 months of treatment with haloperidol or risperidone.Conclusions These data are consistent with the differential activity of the three medications in dorsal striatum structures and suggest that the advantages of olanzapine over haloperidol and risperidone in relation to extrapyramidal syndromes may also generalize to procedural learning. The results also suggest that the procedural learning disadvantages of haloperidol and risperidone accrue slowly but are apparent after 6 months of treatment.A preliminary draft of this paper was presented at the 29th Annual Meeting of the International Neuropsychological Society, Chicago, February 14–18, 2001; and the 5th Biennial Mt Sinai Conference on Cognition in Schizophrenia, Whistler, BC, April 28 to May 2, 2001     

Pharmacy cost evaluation of risperidone,olanzapine, and quetiapine for the treatment of schizophrenia in acute care inpatient settings

SUMMARY

Objective: This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics – risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from ‘labeled costs’. Recent research findings indicate the need for more robust evaluation of such pharmacy costs.

Research design and methods: This study used data from non-randomized inpatient retrospective charts from three acute care inpatient mental health facilities. The final pooled sample included 327 patients, of which 120 received risperidone, 153 received olanzapine, and 54 received quetiapine. Medication cost was defined as the average wholesale price (AWP) as listed in the 2001 ‘Red Book’. Propensity scoring methodology and multinomial regression were employed to reduce treatment selection bias.

Results: The observed mean daily antipsychotic drug doses were 4.45?mg (SD 2.44) for risperidone, 14.04?mg (SD 5.55) for olanzapine, and 350.33?mg (SD 228.24) for quetiapine. The corresponding mean daily drug costs were $7.66(SD $4.20) for risperidone, $8.11 (SD $5.29) for quetiapine and, $12.10 (SD $4.79) for olanzepine. Numbers adjusted for treatment selection bias show that the average daily total pharmacy cost of risperidone was $4.35 lower than olanzapine (?p < 0.001) and $1.41 lower than quetiapine (?p = 0.38). The adjusted average daily pharmacy cost of olanzapine was $4.02 higher than quetiapine (?p < 0.001). After statistical adjustment there were no significant differences between study drugs in terms of length of stay or patient functioning.

Conclusion: This study provides the first US comparison of medication utilization patterns and pharmacy costs for olanzapine, risperidone, and quetiapine administered in acute mental health care inpatient settings. While this study did not estimate the full economic value of the three antipsychotics in these inpatient settings, it demonstrated that the mean daily costs for risperidone were lower than the mean daily costs for olanzapine (?p < 0.001) and quetiapine although the later difference was not statistically significant (?p = 0.38).     

Switching from risperidone to olanzapine in a one-year,randomized, open-label effectiveness study of schizophrenia

ABSTRACT

Objective: Switching medications is common in the treatment of schizophrenia. This study examines the effectiveness of olanzapine therapy following a clinically warranted switch from risperidone during treatment of patients with schizophrenia.

Research design and methods: This post-hoc analysis used data from the risperidone arm of a randomized, open-label, 1-year study of patients with schizophrenia. Study protocol permitted antipsychotic switching when clinically warranted, and outcomes were assessed with standard psychiatric measures. Statistical analyses assessed changes from pre- to post-medication switch and endpoint comparisons between patients switched from risperidone to olanzapine and patients continued on risperidone.

Results: Most patients who switched from risperidone switched to olanzapine (43/60; 71.7%). Average duration of risperidone treatment prior to switching was 86 days (mean modal dose 4.0?mg/day). Most switchers (86%) completed the 1-year study on olanzapine (average duration 241 days; mean modal dose 12.0?mg/day). Following switch to olanzapine, patients experienced significant improvements on clinical (Brief Psychiatric Rating Scale) and social (Quality of Life Inventory) parameters, with similar proportions of patients achieving remission status at endpoint compared with risperidone patients not requiring medication switch (41.9 vs. 35.5%). Mean weight gain for switchers was approximately 0.4?kg while on risperidone (average treatment duration <?3 months) and 2.4?kg on olanzapine (average treatment duration approximately 8 months).

Conclusions: This study suggests that olanzapine is an effective treatment option for schizophrenia patients requiring a switch from risperidone. Given the small sample size and lack of a comparative group, one cannot determine if other medication options would have been as effective as the switch to olanzapine. Thus, further research is warranted.     

奥兰扎平利培酮及氯丙嗪对男性精神分裂症患者催乳素及勃起功能的影响

目的:探讨奥兰扎平、利培酮及氯丙嗪对男性精神分裂症患者催乳素(PRL)水平及勃起功能的影响。方法:60例首发男性精神分裂症患者随机分为奥兰扎平组、利培酮组及氯丙嗪组,检测治疗前、入组4周末及8周末PRL水平,利用男性勃起功能量表评估入组12周末勃起功能状况。结果:入组4周末利培酮组血清PRL水平显著高于氯丙嗪组及奥兰扎平组,氯丙嗪组勃起功能量表分显著低于奥兰扎平组。结论:奥兰扎平对催乳素水平及男性勃起功能的影响相对较小。     

利培酮治疗精神分裂症的临床验证

目的验证利培酮治疗精神分裂症的有效性及安全性。方法对54例精神分裂症住院患者予利培酮1~10mg/d治疗,疗程为8周。以精神病评定量表评定疗效,以不良反应症状量表评定药物不良反应。结果治疗结束时显效率(痊愈 显著好转)为64%,有效率88%。利培酮治疗的起效时间为20d,有效治疗日剂量范围在5.0~6.5mg。较多见的不良反应为头晕、困倦等。结论利培酮对精神分裂症的阳性症状及阴性症状均有较好的疗效。     

奥氮平联合利培酮对精神分裂症患者血清同型半胱氨酸水平的影响

目的 探讨奥氮平联合利培酮对精神分裂症患者血清同型半胱氨酸(Hcy)水平的影响.方法 共纳入60例确诊为精神分裂症的患者,采用数字表法随机分为两组,A组给予单独奥氮平治疗;B组给予奥氮平联合利培酮治疗.随访2个月,观察疗效及对Hcy的影响.结果 治疗前两组Hcy水平[(24.4±6.1) μmol/L、(25.8 ±7.7) μmol/L)]及高同型半胱氨酸血症(HH)例数(22例、23例)差异均无统计学意义(t=1.11,x2=1.34,均P＞0.05);治疗后2个月B组Hcy水平(11.6±8.6) μmol/L及HH例数(16例)明显低于A组[(16.3±3.8)μmol/L、8例](t=4.65,x2=4.32,均P＜0.05).结论 奥氮平联合利培酮治疗精神分裂症有较好的疗效,在改善患者精神分裂症状的同时可以更好的降低患者血清Hcy水平及HH例数.     

奥氮平与利培酮治疗老年精神分裂症患者疗效及执行功能比较

目的:比较奥氮平与利培酮治疗老年精神分裂症的疗效及对执行功能的影响.方法:84例老年精神分裂症患者随机分为奥氮平组(43例)和利培酮组(41例),于治疗前及治疗后第8周末采用阳性与阴性症状量表(PANSS)和威斯康星卡片分类测验( WCST)评定疗效和执行功能,分别比较每组治疗前后及两组间的结果.结果:治疗后奥氮平组的有效率及显效率分别为90.6％和67.4％,利培酮组的有效率及显效率分别为92.6％和68.3％,两者差异无统计学意义(P＞0.05).治疗后奥氮平组的阴性症状分低于利培酮组(P＜0.01).利培酮组WCST的完成分类数低于奥氮平组,持续性错误数和总错误数高于利培酮组(P＜0.01).结论:奥氮平和利培酮均能有效改善老年精神分裂症的症状和执行功能,但奥氮平对阴性症状和执行功能的改善效果更好.     

齐拉西酮与利培酮治疗精神分裂症对照观察

目的探讨齐拉西酮与利培酮相比治疗精神分裂症的临床疗效及安全性。方法将100例精神分裂症患者随机分两组,观察组采用齐拉西酮治疗,对照组采用利培酮治疗。治疗8周后用简明精神病评定量表(BPRS)、阳性症状量表(SAPS)、阴性症状量表(SANS)进行疗效评定。结果 3个量表组内比较时,两组治疗后2、4、8周与治疗前比较,差异均有统计学意义(P<0.05)。各项评定时间组间比较时,两组差异无统计学意义(P>0.05)。观察组疗效优于对照组,两组不良反应有差异。结论齐拉西酮是一种较理想的治疗精神分裂症的药物,其疗效确切,安全性较好,值得临床推广应用。     

奥氮平治疗青少年精神分裂症的临床疗效分析

目的：探讨奥氮平治疗青少年精神分裂症的临床疗效。方法：选择2015年1月～2016年1月我院收治的精神分裂症青少年患者80例,将其平均分为研究组与对照组。对照组采用阿立哌唑治疗,研究组应用奥氮平治疗。结果：研究组治疗总有效率为95.00%,高于对照组的80.00%（P<0.05）;研究组药物不良反应发生率为10.00%,低于对照组的30.00%（P<0.05）。结论：奥氮平治疗青少年精神分裂症疗效确切,安全性佳。     

Dropout rates with olanzapine or risperidone: a multi-centre observational study

Objective In patients with schizophrenia, risperidone and olanzapine are the two most commonly used atypical anti-psychotics. A recent meta-analysis based on randomized trials suggests that, in the long term, olanzapine can have a lower frequency of treatment discontinuation (or dropout) in comparison with risperidone. To better test this hypothesis, our observational study was aimed at assessing whether or not this advantage of olanzapine versus risperidone could be confirmed in a patient series examined in an observational setting.Methods Our study was based on a retrospective multi-centre observational design. We collected the following information from each patient: demographic characteristics; current anti-psychotic treatment (olanzapine or risperidone, under the condition of a stable therapy over months –1 to –4); cumulative dose of the drug; previous anti-psychotic treatment (during months –5, –6, –7 and/or, when available, also before month –7); daily dose and treatment duration. Our primary analysis traced back the patients history from the date of enrollment retrospectively up to month –7. The secondary analysis followed-up the patients history prior to month –7, thus extending this retrospective recording as long as possible (depending on what information was actually available for individual patients).Results The patients were enrolled from 31 institutions. In our primary analysis (months –1 to –7), a total of 144 patients were included; in this subgroup treated with olanzapine or risperidone as initial drug (n=94), we observed 4 of 54 switches from olanzapine to risperidone and 11 of 40 switches from risperidone to olanzapine (P=0.01). A total of 454 patients were enrolled in our secondary analysis (from month –1 up to month –73); the same comparison showed 9 of 236 switches from olanzapine to risperidone and 17 of 150 switches from risperidone to olanzapine (P=0.004).Conclusion Our analysis confirms the results of a recent meta-analysis and shows that olanzapine might imply a lower risk of dropout than risperidone.     

奥氮平与利培酮治疗冰毒所致精神障碍的疗效

目的 探讨奥氮平与利培酮治疗冰毒所致精神障碍的效果。方法 冰毒所致精神障碍患者100例,采用双盲分组法将其分为观察组与对比组,各50例。对比组患者使用利培酮治疗,观察组患者使用奥氮平治疗,对比分析两组治疗前后阳性和阴性症状量表(PANSS)评分和治疗效果。结果 治疗后,观察组一般精神病理评分(19.52±6.32)分、阴性症状评分(14.42±4.25)分均低于对比组的(25.14±6.54)、(16.98±4.18)分,阳性症状评分(56.28±12.71)分高于对比组的(51.16±11.69)分,差异有统计学意义(P<0.05)。观察组治疗总有效率为94.00%,高于对比组的80.00%,差异有统计学意义(P<0.05)。结论 奥氮平治疗冰毒所致精神障碍效果更佳,具有较好的临床应用价值。     

奥氮平与利培酮治疗精神分裂后恢复期心理状态比较研究

目的:以利培酮和正常成人常模为对照,分析比较奥氮平治疗精神分裂症后恢复期心理健康状况.方法:对40例精神分裂症患者随机分为两组,奥氮平研究组(n=21)和利培酮(n=19)及正常成人常模为对照组,于治疗12周末后对研究组和对照组患者进行90项症状白评量表(SCL-90)的问卷调查分析.结果:奥氮平治疗组的SCL-90各个指标中总分、阳性症状均分及阳性项目数与对照组及正常成人常模比较差异无显著性(P>0.05),因子分中的抑郁、焦虑及恐怖因子分显著低于对照组(P<0.01),而与正常成人常模相比差异无显著性.结论:奥氮平治疗精神分裂症,可显著改善患者的心理健康水平,并优于利培酮,可接近正常成人的心理健康水平.     

帕利哌酮与利培酮治疗精神分裂症患者对照研究

目的探讨帕利哌酮与利培酮治疗精神分裂症的疗效与安全性。方法 60例精神分裂症患者随机分为2组各30例,分别给予帕利哌酮与利培酮治疗8周。采用阳性与阴性症状量表(PANSS)、不良反应量表(TESS)评定疗效及不良反应。结果帕利哌酮组显效率80%,利培酮组显效率83.3%,差异无统计学意义(P>0.05)。2组在治疗第2周起PANSS总分均有显著下降(P<0.05和P<0.01),而2组间在治疗各周差异均无统计学意义(P>0.05)。利培酮组的锥体外系不良反应高于帕利哌酮组,差异有统计学意义(P<0.01)。结论帕利哌酮与利培酮治疗精神分裂症的疗效相当。     

喹硫平与利培酮治疗精神分裂症的效果分析

目的 探讨喹硫平与利培酮治疗精神分裂症的效果.方法 选择82例患有精神分裂症的患者,随机分为对照组和治疗组,每组各41例,对照组患者给予利培酮治疗,治疗组患者给予喹硫平治疗.结果 治疗组患者的总有效率为90.2％,显著优于对照组的68.3％,差异有统计学意义（P＜0.05）;治疗组的精神分裂症状控制时间及接受治疗平均时间均明显少于对照组,差异有统计学意义（P＜0.05）;治疗组的不良反应发生率显著低于对照组,差异有统计学意义（P＜0.05）.结论 喹硫平治疗精神分裂症的效果良好,不良反应发生率低,值得临床推广应用.     

奎硫平与利培酮治疗精神分裂症的比较分析

目的：以利培酮为对照，探讨奎硫平治疗精神分裂症的疗效和不良反应。方法：将60例符合CCMD-3诊断标准的精神分裂症病人随机分为两组．分别用奎硫平和利培酮治疗8周，采用阳性症状和阴性症状量表（PANSS）评定临床疗效。用不良反应量表（TESS）评定不良反应。结果：两组治疗8周后的疗效差异无统计学意义（P〉0．05）；奎硫平组和利培酮组的显效率差异无统计学意义（P〉0．05）。结论：奎硫平和利培酮对精神分裂症的疗效相当，不良反应小。     

Changes in cognitive functioning with risperidone and olanzapine treatment: a large-scale,double-blind,randomized study

Objective The effects of risperidone and olanzapine on cognitive functioning in patients with schizophrenia were compared in a randomized, double-blind trial. Method Three hundred and seventy-seven patients were randomly assigned to receive 2–6 mg/day of risperidone or 5–20 mg/day of olanzapine for 8 weeks. Cognitive function was assessed with a focused cognitive assessment battery; in addition, extrapyramidal symptoms were assessed using the extrapyramidal symptom rating scale (ESRS), and the positive and negative syndrome scale (PANSS) was rated for all patients. Results Treatment with these two atypical antipsychotic medications was associated with improved performance on the Wisconsin card sorting test, the trail-making test, the California verbal learning test, the continuous performance test, and some aspects of verbal fluency and spatial working memory. No differences in the effects of the drugs on any of the cognitive tests were noted. Correcting for the effects of anticholinergic treatment did not alter the magnitude of cognitive effects. Conclusions Atypical antipsychotic treatment is associated with wide-ranging benefits on cognitive functioning. Previous reports of greater benefits of olanzapine over risperidone in a small-sample pilot study were not substantiated. These results are not due in general to changes in clinical symptoms or movement disorders, suggesting a direct effect of atypical antipsychotic medications on cognitive deficits in schizophrenia.