帕利哌酮缓释片用于精神分裂症复发的研究进展

帕利哌酮缓释片是目前临床常用的一种非典型抗精神病药物,临床作用机制是主要通过阻断全部的5-羟色胺2A（5-HT2A）受体和部分多巴胺D2（DA2）受体,进而发挥抗精神病的作用。近年来,随着帕利哌酮缓释片在临床上被广泛应用,许多临床研究提示帕利哌酮缓释片可有效控制精神分裂症患者的阳性症状、改善阴性症状和认知损害、提高患者的耐受性和依从性。帕利哌酮缓释片起效快,且可有效改善对其他非典型抗精神病药治疗无效患者的临床效果,为精神分裂症患者的全面康复提供有效的治疗。近年来的统计观察发现,帕利哌酮缓释片应用于急性期及首发精神分裂症患者的临床效果较好,临床治愈率满意,但帕利哌酮缓释片对精神分裂症复发的效果如何尚未报道。本院通过对住院或门诊复发精神分裂症患者应用帕利哌酮缓释片的观察,评价帕利哌酮缓释片治疗精神分裂症复发的临床效果。本研究对帕利哌酮缓释片治疗精神分裂症复发的研究进行综述。     

帕利哌酮棕榈酸盐的临床研究进展

帕利哌酮棕榈酸盐是一种非典型抗精神病药物的长效针剂,活性成分为帕利哌酮,也称9-羟利培酮,主要通过阻断5-羟色胺2A受体和多巴胺D2受体发挥抗精神病药作用。该药在制备过程中采用了特殊的纳米晶体技术,有效提高药物溶解度,使得药物在使用过程中更加安全有效。经试验证实,帕利哌酮棕榈酸盐对精神分裂症急性期治疗和维持治疗效果较好,与现有长效针剂相比具有一定优势,为精神分裂症患者的治疗提供了一种新的选择。     

阿立哌唑的研究状态

目的综述近年来对药物阿立哌唑的研究状态。方法查阅、分析、归纳有关文献。结果目前非典型抗精神病药物应用越来越广泛,不但应用于精神分裂症的治疗,而且作为心境稳定剂治疗情感障碍。结论阿立哌唑对慢性精神分裂症患者的疗效是显著的,而且安全性良好。阿立哌唑的临床使用日趋广泛,在精神病的治疗中发挥了较好的作用。     

抗精神分裂症药帕利哌酮研究进展

帕利哌酮为抗精神失常药利哌酮的主要活性代谢物,为非典型性抗精神病药.本品是一种完全5-羟色胺(HT)2受体和部分多巴胺D2受体的拮抗剂.临床试验结果显示,本品能够有效地改善急性精神分裂症患者的症状,延缓精神分裂症复发以及改善患者睡眠状况.本品由强生公司子公司杨森公司开发,商品名INVEGATM,为帕利哌酮缓释片.2006年12月20日美国FDA批准其用于治疗精神分裂症,是2003年以来FDA批准的首个治疗精神分裂症的处方药[1].强生公司已向欧盟提出上市申请,目前本品在我国已获药品行政保护.本文从释药系统、药效学、药代动力学、临床研究、不良反应等方面对帕利哌酮研究进展进行综述.     

新型非典型抗精神病药物的应用及研究进展

典型抗精神病药能减少精神分裂症的阳性症状,却伴发锥体外系不良反应。新型非典型抗精神病药物相比已有的典型抗精神病药物,具有疗效好、不良反应小等优点,有望为精神分裂症的治疗开创新的局面。本文从药物应用方面综述了自2000年上市的一些非典型抗精神病药物的最新研究进展,期待越来越多的新型非典型抗精神病药物能应用于临床,更好地服务患者。     

齐拉西酮与哌罗匹隆治疗精神分裂症的疗效分析

盐酸齐拉西酮（Ziprasidone）为非典型广谱抗精神病药,为研究国产齐拉西酮治疗精神分裂症的效果和安全性,我们以同属非典型抗精神病药的哌罗匹隆作对照进行研究。报告如下。     

齐哌西酮--一种新型非典型抗精神病药物

2001年2月被美国FDA批准用于精神科临床治疗精神分裂症的一种新型、非典型抗精神病药物--齐哌西酮(ziprasidone,或被译为齐拉西酮、力复君安)[1]即将在我国上市.该药除有片剂外,尚有针剂可供使用.鉴于目前在精神科控制精神分裂症患者急性激越症状的药物选择多为氟哌啶醇和氯丙嗪,因此作为临床上首个以非典型抗精神病药物针剂来控制精神疾病的药物出现,当会引人注目.齐哌西酮由美国辉瑞公司(Pfize)研制,已在美国和日本分别进行Ⅲ期和Ⅱ期临床试验[2].国产齐哌西酮(商品名:力复君安),由重庆圣华曦药业有限公司生产,初步定于上市时间为2005年12月.为便于临床医生了解该药情况,现略作介绍.     

齐哌西酮--一种新型非典型抗精神病药物

2001年2月被美国FDA批准用于精神科临床治疗精神分裂症的一种新型、非典型抗精神病药物--齐哌西酮(ziprasidone,或被译为齐拉西酮、力复君安)[1]即将在我国上市.该药除有片剂外,尚有针剂可供使用.鉴于目前在精神科控制精神分裂症患者急性激越症状的药物选择多为氟哌啶醇和氯丙嗪,因此作为临床上首个以非典型抗精神病药物针剂来控制精神疾病的药物出现,当会引人注目.齐哌西酮由美国辉瑞公司(Pfize)研制,已在美国和日本分别进行Ⅲ期和Ⅱ期临床试验[2].国产齐哌西酮(商品名:力复君安),由重庆圣华曦药业有限公司生产,初步定于上市时间为2005年12月.为便于临床医生了解该药情况,现略作介绍.     

治疗双相抑郁的新型抗精神病药物鲁拉西酮

双相抑郁是双相情感障碍的临床亚型之一,其病程复杂多变,不易识别且治疗困难。鲁拉西酮是一种新型非典型抗精神病药,为多巴胺D2、5-HT2A及5-HT7受体拮抗剂,于2010年被美国食品和药物管理局(FDA)批准用于治疗成人精神分裂症。2013年FDA批准鲁拉西酮新的适应证,可用于成人双相Ⅰ型情感障碍抑郁发作。本文主要对鲁拉西酮在双相抑郁的临床应用及研究进展作一综述,并对该药在精神分裂症中的临床应用及其药理作用机制、药动学、安全性、用法用量等作相应概述。     

新型抗精神病药帕利哌酮缓释片的临床研究进展

帕利哌酮缓释(paliperidone ER)片是于2009年在国内上市的一种新型抗精神病药物。本文比较了帕利哌酮与利培酮在药理学特性和作用机制方面的区别,对帕利哌酮与其他非典型抗精神病类药物如利培酮、喹硫平、奥氮平、阿立哌唑在临床应用以及不良反应等方面的对照研究进展进行了综述。     

Mood alterations during deanol therapy

An imbalance between central cholinergic and adrenergic influences may affect mood disorders. Of 38 patients taking high doses of deanol, a putative acetylcholine precursor, eight developed changes in mood: five became depressed and three became hypomanic. A predisposition is suggested as seven of these eight patients had histories of affective symptoms. There was no relationship between the changes in dyskinesias and mood. These observations have both practical and heuristic implications for the management of patients and for further research into the pharmacology of affective disorders and deanol.     

Atypical antipsychotic agents and increased risk of diabetes: class action or differential action?

Atypical antipsychotic (AAP) agents are useful in treating patients with schizophrenia and other psychosis. Their advantages are the low incidence of extrapyramidal side effects, and possible amelioration of negative, cognitive and mood symptoms. Occurrence of diabetes after AAP drug administration is of concern as patients do not often recognise their symptoms, physicians may fail to diagnose early, with consequent morbidity and mortality. The symptoms of psychosis, including lack of insight and motivation, may decrease the ability of schizophrenic patients to communicate potential health problems. Whether or not AAP drugs induce diabetes and, if they do, if it is a class action or a differential action, is often debated. Clinical evidence on AAP drug-induced diabetes is mounting. With their discontinuation, the diabetes often dissipates, but reappears when they are started again, thereby implicating the AAP drugs in the development of diabetes. There is still dispute regarding the differential effect of the various AAP drugs in their ability to produce diabetes. Although not scientifically proven, available evidence seems to indicate that clozapine and olanzapine may have a higher propensity to induce diabetes compared with other AAP drugs.     

Current concepts in clinical therapeutics: major affective disorders, Part 1

The epidemiology, pathophysiology, diagnosis and clinical features, and treatment of unipolar (depressive) and bipolar (manic-depressive) affective disorders are described. Disturbances of mood are the most common psychiatric disorders in adults, with 18-23% of women and 8-11% of men having at least one major depressive episode. Genetic factors are important in both depression and manic-depressive illness. Depression is characterized by a persistent dysphoric mood accompanied by feelings of sadness or hopelessness nearly every day for at least two weeks. The essential feature of a manic episode is an elevated, expansive, or irritable mood associated with symptoms such as hyperactivity and lack of judgment. Treatment involves nonpharmacologic and pharmacologic interventions. Psychotherapy in patients with depression is most useful in improving social functions, while antidepressant drugs reduce relapse rates. Electroconvulsive therapy is indicated in depressed patients at immediate risk of suicide or extreme incapacitation. Tricyclic antidepressants (amitriptyline, imipramine, doxepin, notriptyline, desipramine, trimipramine), second-generation antidepressants (maprotiline, amoxapine, trazodone, bupropion), monoamine-oxidase inhibitors (phenelzine, isocarboxazid, tranylcypromine, pargyline), and lithium are useful in treating patients with affective disorders. Tricyclic agents are the mainstay of treatment for depression; newer second-generation agents should be used in specific subgroups of patients. Lithium is the drug of choice for prophylaxis in bipolar patients, whereas combinations of lithium and tricyclic agents are useful during acute episodes of depression in bipolar patients. Major affective disorders occur commonly and require a careful balance of pharmacologic and nonpharmacologic interventions for proper therapy.     

Common treatment of polycystic ovarian syndrome and major depressive disorder: case report and review

We present the case of a young woman with treatment-resistant major depression, who presented to the Mood Disorders Clinic with a Hamilton Psychiatric Rating Scale for Depression (HAM-D-21) score of 28, after a year-long treatment with Effexor-XR. The patient also had untreated Polycystic Ovarian Syndrome (PCOS). The resolution of her depressive symptoms resulted from the treatment for PCOS with metformin and spironolactone. The patient remained euthymic 5 months after discontinuation of the antidepressant while continuing therapy for PCOS. We briefly overview of the pertinent literature of the pathophysiology of PCOS and affective disorders, highlighting an overlap in phenotypical presentations between these two disorders. Dysregulation of the hypothalamo-pituitary axis and various end organ systems are implicated in both PCOS and affective disorders. As such, several clinical and biochemical markers are common to both disorders, namely insulin resistance, obesity, and hyperandrogenism. In addition, these metabolic abnormalities are interrelated, causing women with PCOS or affective disorders to get caught in a "vicious cycle" of hormonal dysregulation. The case report presented here illustrates how treatment of symptoms such as insulin resistance and hyperandrogenism can lead to remission of major depressive disorder and PCOS. We suggest that through treatment of underlying metabolic defects, both the mood of the patient and the metabolic condition of PCOS can be assisted.     

Allopregnanolone as a mediator of affective switching in reproductive mood disorders

Rationale

Reproductive mood disorders, including premenstrual dysphoria (PMD) and postpartum depression (PPD), are characterized by affective dysregulation that occurs during specific reproductive states. The occurrence of illness onset during changes in reproductive endocrine function has generated interest in the role of gonadal steroids in the pathophysiology of reproductive mood disorders, yet the mechanisms by which the changing hormone milieu triggers depression in susceptible women remain poorly understood.

Objectives

This review focuses on one of the neurosteroid metabolites of progesterone — allopregnanolone (ALLO) — that acutely regulates neuronal function and may mediate affective dysregulation that occurs concomitant with changes in reproductive endocrine function. We describe the role of the “neuroactive” steroids estradiol and progesterone in reproductive endocrine-related mood disorders to highlight the potential mechanisms by which ALLO might contribute to their pathophysiology. Finally, using existing data, we test the hypothesis that changes in ALLO levels may trigger affective dysregulation in susceptible women.

Results

Although there is no reliable evidence that basal ALLO levels distinguish those with PMD or PPD from those without, existing animal models suggest potential mechanisms by which specific reproductive states may unmask susceptibility to affective dysregulation. Consistent with these models, initially euthymic women with PMD and those with a history of PPD show a negative association between depressive symptoms and circulating ALLO levels following progesterone administration.

Conclusions

Existing animal models and our own preliminary data suggest that ALLO may play an important role in the pathophysiology of reproductive mood disorders by triggering affective dysregulation in susceptible women.     

Mood disorders and substance use disorder: a complex comorbidity

Mood disorders, including depression and bipolar disorders, are the most common psychiatric comorbidities among patients with substance use disorders. Treating patients' co-occurring mood disorders may reduce their substance craving and taking and enhance their overall outcomes. A methodical, staged screening and assessment can ease the diagnostic challenge of distinguishing symptoms of affective disorders from manifestations of substance intoxication and withdrawal. Treatment should maximize the use of psychotherapeutic interventions and give first consideration to medications proven effective in the context of co-occurring substance abuse. Expanded communication and collaboration between substance abuse and mental health providers is crucial to improving outcomes for patients with these complex, difficult co-occurring disorders.     

The role of C-reactive protein in mood disorders

Recently, a possible relationship between C-Reactive Protein (CRP), a marker of underlying low-grade inflammation, and mood disorders has been proposed by some researchers. The aim of this review is to elucidate the current facts and views about CRP in mood disorders such as Depressive and Bipolar Disorders. Several studies have examined the relationship between affective disorders and CRP, but the majority of the studies in literature have been limited by retrospective, case-controlled study design, and very few studies have examined the relationship between depression and CRP in large study samples. In conclusion, the role of CRP in mood disorders is, to date, intriguing but somewhat unclear. Further prospective studies are needed to introduce the CRP in clinical settings as a marker of affective states and suicidability.     

A therapeutic role for cannabinoid CB1 receptor antagonists in major depressive disorders

Cannabinoid receptors in the CNS have been implicated in the control of appetite, cognition, mood and drug dependence. Recent findings support the hypothesis that cannabinoid CB1 receptor blockade might be associated with antidepressant and anti-stress effects. A novel potential antidepressant drug class based on this mechanism is supported by the neuroanatomical localization of CB1 receptors and signal transduction pathways that are involved in emotional responses, together with the antidepressant-like neurochemical and behavioral effects induced by CB1 receptor antagonists. Selective CB1 receptor antagonists are in development for the treatment of obesity and tobacco smoking, and could be tested for antidepressant efficacy because recent results of clinical studies suggest that they would also treat comorbid symptoms of depression such as cognitive deficiencies, weight gain, impulsivity and dependence disorders. Thus, CB1 receptor antagonism might constitute an integrated pharmacotherapeutic approach that impacts the affective, cognitive, appetitive and motivational neuronal networks involved in mood disorders.     

Oral contraceptives and neuroactive steroids

A deregulation in the peripheral and brain concentrations of neuroactive steroids has been found in certain pathological conditions characterized by emotional or affective disturbances, including major depression and anxiety disorders. In this article we summarize data pertaining to the modulatory effects of oral contraceptive treatment on neuroactive steroids in women and rats. Given that the neuroactive steroids concentrations are reduced by oral contraceptives, together with the evidence that a subset of women taking oral contraceptives experience negative mood symptoms, we propose the use of this pharmacological treatment as a putative model to study the role of neuroactive steroids in the etiopathology of mood disorders. Moreover, since neuroactive steroids are potent modulators of GABA(A) receptor function and plasticity, the treatment with oral contraceptives might also represent a useful experimental model to further investigate the physiological role of these steroids in the modulation of GABAergic transmission.