住院精神分裂症患者抗精神病药使用现状

目的调查2010年7所精神疾病专科医院住院精神分裂症患者抗精神病药(APD)使用现状。方法以2010年7月12至14日为时点调查日,对全国5省市7所精神疾病专科医院的1024例精神分裂症住院患者使用自制调查表进行APD使用的现况调查。结果 (1)1024例患者中,男652例(63.7%),女372例(36.3%)。(2)1010例(98.6%)患者接受了APD治疗,药物使用频率依次为:利培酮378例次(36.9%)、氯氮平295例次(28.8%)、奎硫平118例次(11.5%)、阿立哌唑101例次(9.9%)、氯丙嗪78例次(7.6%)齐拉西酮64例次(6.3%)、奋乃静59例次(5.8%)、奥氮平59例次(5.8%)、舒必利56例次(5.5%)。(2)非典型APD的使用频率为87.7%;典型APD的使用频率为22.8%;3.03%的患者接受了长效药物治疗。(3)72.36%的患者接受了单一抗精神病药治疗;26.27%的患者联合使用2种或2种以上APD。(4)合用药物主要是抗胆碱能药(25.00%)、苯二氮类药物(20.61%)、β-受体阻滞剂(19.34%)和心境稳定剂(11.72%),主要用于控制不良反应或增效治疗。结论非典型APD已经成为我国治疗精神分裂症的主流药物,APD的使用比较合理规范,但尚有不足。     

住院精神分裂症患者抗精神病药使用情况比较

为了解我院精神分裂症住院患者抗精神病药（APD）10年前后使用变迁状况,对不同年代的用药进行了调查,现将结果分析如下.     

民政医院精神分裂症患者抗精神病药使用现状

目的:调查民政医院精神分裂症住院患者抗精神病药(APD)的使用现状及影响因素。方法:以2005年2月20至23日为时点调查日,对全国13所不同省份的民政医院精神分裂症住院患者进行抽样调查。结果:①在1401例患者中,收容患者832例(59.4%),收费患者569例(40.6%),二者比较,收容患者男性比例高、年龄大、住院时间长(P均<0.01);②使用频率在前7位的药物依次是氯氮平、氯丙嗪、奋乃静、舒必利、氟哌啶醇、利培酮、奎硫平;③接受单一APD治疗932例(67.5%),联合使用2种及以上APD449例(32.5%);使用典型APD960例(69.5%),使用非典型APD(包括氯氮平)802例(58.1%),接受长效APD25例(1.8%)。结论:民政医院精神分裂症住院患者使用APD仍以典型APD为主,付费方式、经济负担和患者症状对精神药物的选择影响较大。     

最新抗精神病药

在沉寂了十几年以后,最近又涌现了不少新的抗精神病药。随着利培酮(rispcridonc)在美国跃居抗精神病药应用量的榜首之后,奥兰扎平(olanzapine)也已获得FDA批准上市。接下来又将有几个新品种出现于精神病治疗学的舞台。正像1960年代初那样,新药辈出,犹如雨后春笋。新一代抗精神病药的特点是:对     

基层抗精神病药使用现状调查

本研究对北京市两所二级精神病专科医院住院精神分裂症患者抗精神病药治疗状况进行调查，报告如下。     

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。     

住院精神分裂症并发糖尿病患者与抗精神病药物应用的关系分析

目的探索抗精神病药物与精神分裂症伴发糖尿病的临床关系。方法观察445例住院精神分裂症患，将氯丙嗪、氯氮平、利培酮及氯氮平合并氯丙嗪分组比较，研究药物种类、住院治疗时间对血糖的影响程度。结果血糖增高和糖尿病的发生率分别为19．78％和12．13％，都以氯氮平合并氯丙嗪组最高，氯氮平次之；氯丙嗪组、氯氮平组及氯氮平合并氯丙嗪组末次血糖浓度明显高于首次血糖浓度。除利培酮组外，住院治疗1～10年的血糖浓度明显增高，但10年后氯氮平组仍有增高趋势。结论氯氮平合并氯丙嗪对血糖代谢影响最大，氯氮平具有更长远的不利影响，使用抗精神病药物时应定期监测血糖。     

抗精神病药对长期住院患者体重的影响

对长期住院的精神分裂症患者进行体重研究。     

抗精神病药与精神分裂症认知功能

本文综述了精神分裂症存在的主要认知缺陷,测试方法和抗精神病药对精神分裂症认知功能的影响。认知功能缺陷是克雷丕林所描述精神分裂症的核心特征,且不能由精神症状等精神病理学解释。精神分裂症的认知缺陷主要包括注意障碍、记忆障碍、抽象思维障碍和信息整合障碍４个方面。注意障碍包括听觉和视觉注意障碍,是引起病人信息加工困难的主要原因。注意障碍又可分注意分散和监控性注意障碍,注意专注和转移困难,选择性注意障碍和警觉性降低。记忆障碍一般是广泛性的,涉及记忆系统的各个部分。精神分裂症的记忆缺陷可表现为故事的复述,言…     

山东省三级医院精神分裂症患者抗精神病药物使用现状分析

目的　了解山东省三级医院抗精神病药的使用现状并作分析。方法　于 2 0 0 0年 9月 2 8日调查省、市、县级住院精神分裂症患者的抗精神病药使用情况 ,并与 1989年的调查进行比较分析。结果　非典型抗精神病药物虽被广泛应用 ,但不同医院使用品种不同。用药方式以单一使用为主 ,常用药物的剂量较1989年有不同程度的下降 ,不良反应的发生率减少。结论　抗精神病药物使用的合理性仍有待提高     

Schizophrenia risk gene CAV1 is both pro-psychotic and required for atypical antipsychotic drug actions in vivo

Caveolin-1 (Cav-1) is a scaffolding protein important for regulating receptor signaling cascades by partitioning signaling molecules into membrane microdomains. Disruption of the CAV1 gene has recently been identified as a rare structural variant associated with schizophrenia. Although Cav-1 knockout (KO) mice displayed no baseline behavioral disruptions, Cav-1 KO mice, similar to schizophrenic individuals, exhibited increased sensitivity to the psychotomimetic N-methyl--aspartate receptor antagonist phencyclidine (PCP). Thus, PCP disruption of prepulse inhibition (PPI) and PCP-induced mouse locomotor activity were both enhanced by genetic deletion of Cav-1. Interestingly, genetic deletion of Cav-1 rendered the atypical antipsychotics clozapine and olanzapine and the 5-HT_2A-selective antagonist M100907 ineffective at normalizing PCP-induced disruption of PPI. We also discovered that genetic deletion of Cav-1 attenuated 5-HT_2A-induced c-Fos and egr-1 expression in mouse frontal cortex and also reduced 5-HT_2A-mediated Ca²⁺ mobilization in primary cortical neuronal cultures. The behavioral effects of the 5-HT_2A agonist (2,5-dimethoxy-4-iodoamphetamine) including head twitch responses and disruption of PPI were also attenuated by genetic deletion of Cav-1, indicating that Cav-1 is required for both inverse agonist (that is, atypical antipsychotic drug) and agonist actions at 5-HT_2A receptors. This study demonstrates that disruption of the CAV1 gene—a rare structural variant associated with schizophrenia—is not only pro-psychotic but also attenuates atypical antipsychotic drug actions.     

Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders

BACKGROUND: Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. METHODS: To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. RESULTS: Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. CONCLUSION: Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.     

Augmentation with sulpiride for a schizophrenic patient partially responsive to clozapine

OBJECTIVE: Schizophrenic patients who are only partially responsive to clozapine pose a therapeutic challenge. In these circumstances some clinicians would consider adding in a second antipsychotic. We present a case report and review evidence for the efficacy of such augmentation strategies. METHOD: Single case report and literature review. RESULTS: The total number of patients in studies and case reports of combining clozapine with other antipsychotics is small. There has been only one randomized controlled trial. This found the addition of sulpiride to clozapine resulted in clinical improvement in some patients. CONCLUSION: Further randomized controlled studies of augmentation of clozapine therapy are needed to provide scientific justification for this clinical practice.     

Effects of antipsychotic drugs on memory functions of schizophrenic patients.

In this research we investigated the effects of 4 antipsychotic drugs with different anticholinergic components on different memory functions of schizophrenic patients. Drugs were administered in cumulative doses and memory was tested 90 min after each drug was administered. The results show that chlorpromazine and thioridazine impaired short-term verbal memory after 6 h of sequential administration. Trifluoperazine and haloperidol improved short-term verbal memory from the third to the fifth administration. Immediate memory, long-term memory and visual short-term memory were not impaired by any drug.     

抗精神病药对精神分裂症患者认知功能的影响

目的：比较利培酮和氯氮平对精神分裂症患者认知功能的影响。方法：对58例精神分裂症患者随机分成两组,分别给予利培酮、氯氮平治疗8周。治疗前和治疗8周末分别进行简明精神病评定量表(BPRS)、韦氏成人记忆量表修订本(WMS-RC)、威斯康星卡片分类测验(WCST)和数字划销测验(CT)评定,比较利培酮和氯氮平对精神分裂症患者认知功能的影响。结果：两组8周后,各项检查项目均有显著好转。结论：利培酮和氯氮平均能改善精神分裂症患者的认知功能。     

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。     

精神分裂症患者服药依从性的调查

目的:调查社区精神分裂症患者服药依从性及其相关因素。方法:对287例免费服药治疗的精神分裂症患者进行病程,一般情况调查表,自知力,服药依从性与简明精神病评定量表(BPRS),社会功能缺陷筛选量表(SDSS)及治疗中出现的症状量表(TESS)的评定与分析。结果:服药依从者70.7%;病程>5年者依从性比≤5年者差;文化程度初中及以下;服用经典抗精神病药组(包括氯氮平);自知力障碍重者依从性差;BPRS总分其思维障碍、敌对猜疑因子分越高者依从性越差;SDSS及TESS(严重度)评分越高者依从性越差。结论:提示患者文化程度高、社会支持系统好、药物不良反应小、有自知力者服药依从性好。     

Rethinking antipsychotic formulary policy

In this commentary, we review recent research suggesting that (a) second-generation antipsychotics (SGAs) may be no more effective than first-generation antipsychotics (FGAs), (b) the reduced risk of EPS and tardive dyskinesia with SGAs is more weakly supported by the research literature than has been appreciated, and (c) benefits may be offset by greater metabolic risks of some SGAs and their substantially greater cost. Bearing in mind, as well, that risperidone, currently the least expensive SGA, will soon be available as an even less expensive generic drug, we propose a new algorithm for maintenance antipsychotic therapy. We further outline a cautious implementation procedure that relies on standardized documentation and feedback, without a restrictive formulary that would limit physician choice. The algorithm outlined here and the process for its implementation are intended as a stimulus for discussion of potential policy responses, not as a finalized proposition.