住院精神分裂症患者药物使用现况调查

目的调查2013年5月在上海交通大学医学院附属精神卫生中心住院的精神分裂症患者药物使用情况。方法本次研究为横断面研究,以2013年5月22日为时点调查日,对我院802例精神分裂症住院患者使用自制调查表进行药物使用的现况调查。结果（1）单一使用抗精神病药物患者比例为43．45％。（2）抗精神病药物使用频度前5位：氯氮平421例（52．56％）,奥氮平225例（28．09％）,利培酮196例（24．47％）,阿立派唑158例（19．73％）,奎硫平126例（15．73％）。（3）精神分裂症患者中合并糖尿病的比例为21．70％,且年龄因素、是否使用氯氮平治疗与糖尿病的发生有相关性。（4）精神分裂症患者中合并高血压的比例为33．04％,且年龄因素与高血压的发生有相关性。结论我院单一用药比例低,氯氮平的使用率高,抗精神病药物的治疗仍需进一步规范。精神分裂症患者中合并糖尿病、高血压的比例高,年龄因素可增加糖尿病、高血压的发生率,服用氯氮平可增加糖尿病的发生率。     

482例门诊精神病患者使用药物情况分析

目的了解门诊精神病患者抗精神病药物的使用情况,为临床合理用药提供参考。方法采用回顾性调查方法调查广东省第三荣军医院2014年9月、11月门诊482张抗精神病药处方用药情况。结果 482张处方共涉及30种治疗方案,其中使用一种抗精神病药物的治疗方案有9种,279张(57.88%),使用2种抗精神病药物的治疗方案有18种,197张(40.87%),使用3种抗精神病药物的治疗方案有3种,6张(1.24%)。抗精神病药物治疗方案居前5位的依次是利培酮(31.90%)、舒必利(13.98%)、利培酮+氯氮平(13.20%)、奥氮平(12.54%)、氯氮平(11.93%),使用率居前5位的分别是利培酮(35.89%)、奥氮平(21.37%)、氯氮平(18.67%)、舒必利(15.35%)、帕罗西汀(8.71%)。结论我院门诊抗精神病药物单一用药方案占主导;非典型抗精神病用药已成为临床首选。     

三所医院住院精神分裂症患者用药情况调查

目的 了解目前住院精神分裂症患者精神药物的应用情况。方法 采用一日法，于2000年6月6日用自制调查表对三所医院进行了调查，共计623例。结果 住院精神分裂症患者单一用药以氯氮平居首位(46．2％)，其次为利培酮(15．5％)；合并用药以氯氮平合用舒必利(43．7％)、氯氮平舍用利培酮(20．4％)最为常用；安坦的使用率明显下降。结论 非典型抗精神病药已成为目前住院精神分裂症患者最常用的精神药物。     

抗精神病药对精神分裂症患者体重的影响

目的 为了探讨抗精神病药对精神分裂症患者体重的影响。方法 295例服用抗精神病药的精神分裂症患者进行了临床调查。结果 67．12％患者出现体重增加；体重增加从多到少的药物依次是氯氮平、奥氮平、氯氮平合并利培酮、氯丙嗪、利培酮、氯氮平合并舒必利；氯氮平、氯丙嗪、利培酮体重增加较人组前有显著差异；女性患者、初次服抗精神病药者、合并心境稳定剂者体重增加亦明显。结论 大部分抗精神病药可导致体重增加，应在治疗前及治疗中定期进行体重监测。     

精神分裂症治疗指南对抗精神病药物使用的影响

目的 了解精神分裂症治疗指南出台后,我院住院精神分裂症患者抗精神病药物应用的演变情况.方法 采取整群入组法,调查我院2008年住院精神分裂症患者抗精神病药物的使用情况,并与精神分裂症治疗指南出台前的2003年比较.结果 抗精神病药物的使用频度发生了显著变化,新型抗精神病药物的使用增多,临床药物治疗以单一用药为主.结论 治疗指南的出台,对临床用药起到了规范作用,抗精神病药的选择受多种因素的影响.     

首发精神分裂症502例住院治疗现状调查

目的了解首发精神分裂症患者住院治疗情况。方法采用自制问卷对本中心首发精神分裂症患者502例的临床一般资料、住院治疗用药、疗效、治疗后体重变化及糖脂代谢等情况进行调查分析,并与同期住院的复发患者832例比较。结果本中心首发住院精神分裂症患者占住院治疗患者的37.6(,平均年龄(27.02±9.66)岁,平均病程(0.93±1.56)年,治疗用药82.3(首选新型抗精神病药,其中首选奎的平50.2(,维思通13.7(。复发住院精神分裂症患者首选氯氮平22.1(,奎的平32.2(。首发分裂症患者合并ECT治疗9.2(、复发分裂症患者合并ECT治疗5(。住院期间部分患者体重增加明显,体重增加大于3公斤首发分裂症患者140例42.2(,复发分裂症患者220例35.4(。糖脂代谢异常率复发患者显著大于首发患者。结论非典型抗精神病药物已成为本中心首发精神分裂症患者的首选用药,临床用药比较规范。药物治疗对患者的糖脂代谢、体重增加等方面有明显的副作用,应引起临床关注,建议定期监测。     

苏州市精神分裂症患者抗精神病药物使用现况调查

目的:调查苏州市精神分裂症患者抗精神病药物使用现况。方法:采用患者药物使用调查表,对苏州市3家精神疾病专科医院的544例住院和门诊精神分裂症患者进行抗精神病药物使用情况调查。结果:使用居前6位的抗精神病药物分别是氯氮平(25.6%)、利培酮(16.5%)、奥氮平(13.9%)、奎硫平(11.4%)、阿立哌唑(9.1%)、氯丙嗪(6.8%)。门诊和住院患者抗精神病药物使用频率存在差异(χ2=37.361,P=0.003)。门诊患者氯氮平、利培酮、奥氮平、奎硫平、阿立哌唑、氯丙嗪、奋乃静、帕利哌酮的使用剂量低于住院患者;舒必利、齐拉西酮、氟哌啶醇使用剂量高于住院患者(P均0.01)。单一抗精神病药治疗的比率(54.4%,293例)高于联合药物治疗(45.6%,246例);单一药物治疗者中84.2%(247例)使用第2代抗精神病药(SGAs);联合用药者中97.8%(241例)主要抗精神病药物及65.0%(160例次)次要药物为SGAs;最常合并使用的药物是镇静催眠药(20.2%)、心境稳定剂(12.2%)、抗胆碱能药(12.1%)、抗抑郁药(7.8%)和β-受体阻断剂(4.3%)。结论:单一用药和选择SGAs是苏州市精神分裂症患者药物治疗的主要方式。     

氯氮平药物相互作用研究新进展

氯氮平是目前公认的治疗精神分裂症最有效的抗精神病药,也用于治疗情感性精神障碍、迟发性运动障碍、难治性强迫症等非精神病性障碍[1].虽然氯氮平是一线用药还是二线用药尚有争论,但目前氯氮平在临床上广泛应用也是不争的事实.司天梅等[2]对我国10省市抗精神病药处方的现况调查显示,氯氮平排在第1位(31.7％).在临床上,氯氮平常与其他抗精神病药、抗抑郁药、心境稳定剂、抗胆碱能药、苯二氮(卓)(BDZ)类药和心血管药等联用或合用[2],还可能与精神病患者合并躯体疾病时的治疗药物,如抗结核药、抗糖尿病药、抗生素、激素等合用.然而,氯氮平的代谢在肝脏细胞色素P450( cytochrome P450,CYP)酶系有多种酶参与,且由于多受体作用而药理机制复杂,容易与其他药物产生具有临床意义的药物相互作用,导致药理作用和毒副反应的改变.因此,掌握氯氮平的药物相互作用,对指导临床合理用药具有重要意义.     

住院精神分裂症患者抗精神病药物联合治疗的处方调查

目的了解住院精神分裂症患者抗精神病药物联合治疗(APP)的情况,为精神分裂症的临床用药提供参考。方法连续入组2014年1月1日-12月31日在广州医科大学附属脑科医院住院的精神分裂症患者,收集患者的社会人口学资料,使用临床总体印象量表-病情严重程度量表(CGI-SI)评估患者疾病严重程度,在患者出院日记录抗精神病药物的使用情况,比较接受单一抗精神病药物治疗患者(单药组)与接受APP患者(APP组)的临床特点,描述APP中具体抗精神病药物的使用情况。结果共入组801例住院精神分裂症患者,其中364例(45.4%)使用APP。与单药组相比,APP组发病年龄更小、本次住院时间和总病程更长、住院次数更多,差异均有统计学意义(P均0.05)。APP组中78.0%的患者为同时使用两种第二代抗精神病药物(SGA),常见的联用方式为利培酮(47.3%)、氯氮平(44.5%)和奥氮平(40.1%)联合另一种抗精神病药物。结论住院精神分裂症患者中,接受APP方案的患者发病较早且病程迁延;两种SGA联用是APP中最常见的疗法,APP方案中使用频率最高的药物依次为利培酮、氯氮平和奥氮平。     

首发首诊住院分裂症患者精神药物使用情况调查

目的 了解首发首诊住院分裂症患者精神药物的使用情况。方法 自2000年全部首次住院病例中，选择符合CCMD-2-R精神分裂样精神病标准者673例。结果 首选单一用药者587例(92．15％)，常用药物依次为氟哌啶醇占64．52％，氯氮平占14．76％，氯丙嗪占7．69％，舒必利占2．83％，其他药物的使用率均不足1％，首选联合用药者50例(7．85％)，最常见的是氯氮平联合舒必利占4．71％，合用安坦者510例(80．06％)。结论 对初治分裂症的首选用药，仍以经典抗精神病药为主，不应联合用药，必要时可舍用增效剂，氯氮平不宜做为首选用药。     

EEG abnormalities during treatment with typical and atypical antipsychotics.

OBJECTIVE: Clozapine produces EEG abnormalities and dose-dependent risk of epileptic seizures. Much less is known about EEG effects of newer antipsychotics. The present study therefore examined the risk of EEG abnormalities associated with various antipsychotic drugs. METHOD: EEG recordings from 323 hospitalized psychiatric patients (293 treated with antipsychotics, 30 who did not receive any antipsychotic treatment) were graded blind to diagnosis and treatment for type and severity of EEG abnormalities. Drug type, dose, and clinical factors were evaluated for association with EEG abnormalities by multivariate logistic regression. RESULTS: EEG abnormalities occurred in 56 subjects (19.1%) treated and four (13.3%) not treated with antipsychotics. EEG abnormality risk among antipsychotic agents varied greatly (clozapine=47.1%, olanzapine=38.5%, risperidone=28.0%, typical neuroleptics=14.5%, quetiapine=0.0%). Significant risk factors in order of influence were hypertension, use of an atypical antipsychotic, bipolar diagnosis, and older age; benzodiazepine cotreatment lowered risk. Unassociated with risk were sex, treatment response, length of hospital stay, drug potency, daily dose (in mg or mg/kg), drug exposure time, or cotreatments. CONCLUSIONS: EEG abnormality risk varied widely among specific antipsychotics. Risk was particularly high with clozapine and olanzapine, moderate with risperidone and typical neuroleptics, and low with quetiapine. Comorbid hypertension, bipolarity, and older age-but not dose or clinical response-were associated with risk.     

Different influences of classical antipsychotics and clozapine on glucose-insulin homeostasis in patients with schizophrenia or related psychoses

BACKGROUND: The aim of this study was to investigate the influence of classical antipsychotics and the atypical antipsychotic agent clozapine on glucose-insulin homeostasis to explain possible mechanisms behind weight gain associated with antipsychotic treatment. METHOD: Twenty-eight patients on therapy with classical antipsychotics and 13 patients treated with clozapine (all meeting DSM-III-R criteria for schizophrenia or related psychoses) were studied. Fasting blood samples for glucose and insulin, as well as for 2 markers of the glucose-insulin homeostasis, i.e., the growth hormone (GH)-dependent insulin-like growth factor I (IGF-I) and the insulin-dependent insulin-like growth factor binding protein-1, were analyzed. Body mass index (BMI) was calculated and serum concentrations of the different antipsychotic drugs were measured. In addition, the relationship between the endocrine parameters and drug serum concentrations was examined. RESULTS: The insulin levels were positively correlated to the serum concentration of clozapine, whereas no correlations were found between insulin and the serum concentrations of perphenazine (N = 12) or zuclopenthixol (N = 9). Insulin elevation was seen in the patients receiving clozapine more frequently than in the patients receiving classical antipsychotics. In addition, the median level of IGF-I was significantly lower in the patients receiving clozapine than in the patients receiving classical antipsychotics. No significant difference in BMI was found between the 2 patient groups, and all patients but 1 were normoglycemic. CONCLUSION: The correlation between insulin and the clozapine concentration indicates a probable influence of clozapine on insulin secretion. The normal blood glucose levels in the clozapine group support the theory that clozapine induces concentration-dependent insulin resistance with secondary increased insulin secretion. In addition, lower median level of IGF-I in patients receiving clozapine compared with patients receiving classical antipsychotics points to a lower GH secretion in the clozapine group. This impaired GH secretion together with the clozapine-induced insulin resistance might be mechanisms behind weight gain during clozapine therapy.     

Effect size of symptom status in withdrawal of typical antipsychotics and subsequent clozapine treatment in patients with treatment-resistant schizophrenia

OBJECTIVE: In light of the efficacy of newer antipsychotic agents and the possibility that drug withdrawal may negatively affect subsequent drug response, concern has arisen that the use of placebo in schizophrenia research may be unethical. This study examines the effect size of symptom exacerbation during drug washout with placebo and the effects of drug washout on the efficacy of subsequent drug treatment. METHOD: Fifty patients with treatment-resistant schizophrenia hospitalized on a research unit participated in a double-blind longitudinal study of the effects of drug washout after chronic treatment with a typical antipsychotic and before prospective treatment with clozapine. Brief Psychiatric Rating Scale (BPRS) scores were analyzed to examine drug effects and effect sizes for baseline treatment with a typical antipsychotic (>6 months treatment), drug washout with placebo (mean=34 days), early treatment with clozapine (mean=42 days, mean dose=345.0 mg/day), and optimal clozapine treatment (mean=83 days, mean dose=450.5 mg/day). RESULTS: Patients' BPRS total, positive, and negative symptom scores significantly increased during placebo washout, compared with baseline treatment, and significantly decreased with administration of clozapine, compared with placebo washout and baseline treatment. However, 30% of patients showed some symptom improvement during placebo washout. The effect sizes for the BPRS total score were 0.63 for baseline treatment versus placebo washout, 1.10 for optimal clozapine treatment versus placebo washout, and 0.82 for optimal clozapine treatment versus baseline treatment. CONCLUSIONS: Symptom exacerbation induced by drug withdrawal in patients with treatment-resistant schizophrenia did not impede subsequent responsiveness to clozapine. The effect size for clozapine, compared with typical antipsychotics, suggests that the drug-washout longitudinal design is useful for establishing a drug-free baseline and for investigating drug response, while requiring relatively few subjects.     

Alcohol and cannabis use in schizophrenia: effects of clozapine vs. risperidone

BACKGROUND: Alcohol and cannabis use disorders worsen the course of schizophrenia. While the typical antipsychotics are of limited value in controlling substance use in schizophrenic patients, previous studies suggest that the novel antipsychotic clozapine (CLOZ) may decrease their substance use. We describe a retrospective study of the effects of the novel antipsychotics risperidone (RISP) and clozapine on alcohol and cannabis use in patients with schizophrenia or schizoaffective disorder and comorbid alcohol and/or cannabis use disorder. METHOD: This study involved retrospective assessment of abstinence (cessation of alcohol and cannabis use) in 41 patients treated with either risperidone (n=8) or clozapine (n=33) for at least 1 year. In 32 of these 41 patients, information was available on whether abstinence occurred during the 1-year period. RESULTS: Abstinence rates were significantly higher in patients treated with clozapine than in those treated with risperidone (54% vs. 13%, p=0.05). The nine patients treated for at least 1 year, but excluded from the analysis because time of cessation of use was not known, had all stopped alcohol/cannabis use during clozapine treatment. DISCUSSION: While the limitations of this retrospective study must be recognized, the data suggest that comorbid patients treated with clozapine are more likely to abstain from alcohol and cannabis use than are those treated with risperidone. Further prospective studies will be required to confirm these intriguing results.