住院精神障碍患者抗精神病药物一日处方调查

目的 了解我院住院精神障碍患者抗精神病药物的使用情况及其用药规律.方法 采用一日法对本院住院精神疾病患者的抗精神药物应用状况进行调查.结果 (1)住院精神疾病种类构成发生了一些变化;(2)两药联用与单药治疗并重;(3)药物以利培酮处方量第一;(4)St精神病药物的使用剂量基本都在推荐的安全剂量之内.结论 目前本院药物使用以非典型抗精神药物为主,抗精神病药物使用合理.     

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。     

门诊首次治疗首发精神分裂症的用药情况分析

目的：了解首发精神分裂症患者门诊用药情况。方法：采用自行设计的调查表对1995年1月－10月及2001年1月－10月在门诊首次治疗的首发精神分裂症患者用药及一般资料进行调查.结果：1995年共有158例,其中单用抗精神病药物（APD）142例（89．87％）,以氮氮平为首 ;联合用APD16例（10．13％）,以氯氮平联合舒必利为首 ;预防性应用发坦18例（11．39％）;合用苯二氮Zhuo类药物(BZD)20例（12．66％）。200年共有180例,其中单用APD133例（73．98％）,以利培酮为首;联用APD47例（26．11％）,以氯氮平联合舒必利为首;预防性应用安坦23例（12．78％）;合用BZD46例（25． 66％）。结论：目前门诊首发精神分裂症患者首次治疗时单用APD以利培酮为首选,不主张联合用药及预防性应用安坦。     

Tolerability and effectiveness of atypical antipsychotics in male geriatric inpatients

The atypical antipsychotics are gradually becoming the mainstay of treatment for psychosis in the elderly. The present study examines the effectiveness and tolerability of risperidone and olanzapine treatment in 34 matched male patients admitted to a VA Medical Center geriatric inpatient unit. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Cohen-Mansfield Agitation Inventory (CMAI), the Rating Scale for Side-Effects, the Extra-Pyramidal Rating Scale, and the Mini-Mental State Examination were administered at admission and discharge. T-tests at admission and discharge across groups indicate that the patients as a whole were performing significantly better following their stay on the CMAI (t(30)=4.31, p=0.000), the GAF (t(31)=9.73, p=0.000), the PANSS total score (t(29)=3.82, p=0.001), and the positive symptom portion of the PANSS (t(28)=4.29, p=0.000). No significant differences were detected between the two groups with regard to length of hospitalization, or reduction in scores on the PANSS, or CMAI, however the daily cost of risperidone was 1/3 as much as olanzapine (p=0.00). The two treatments were comparable in the elderly men evaluated in this study.     

住院精神疾病患者抗精神病药物处方时点调查

目的了解住院精神疾病患者抗精神病药物的处方情况。方法采用一日法对上海市精神卫生中心(总部)住院精神疾病患者的精神药物应用状况进行调查。结果(1)住院精神疾病种类构成发生了一些变化;(2)氯氮平处方量第一,新型精神药物的使用正在逐步扩大;(3)联合用药治疗在住院患者中非常多见;(4)抗精神病药物的使用剂量基本都在推荐的安全剂量之内。结论各种抗精神病药物的处方情况发生了较大改变,对于药物的选择和用量考虑其疗效的同时也要兼顾到不良反应的影响。药物选择多样化、新型化、安全使用精神药物已成为目前临床用药的趋势。     

某精神病院住院患者药物使用时点调查

目的了解某精神病院住院患者药物使用状况,提高医院临床合理用药水平。方法利用天津市安宁医院HIS系统对全部住院患者采用一日法进行用药时点调查。结果当日共调查616例患者,其中单用一种抗精神病药有499例(81.0%),联用两种59例(9.6%),联用三种1例(0.2%)。抗精神病药总用药例次为635,其中利培酮使用频度居首位317例(49.9%),其次为氯氮平163例(25.7%),喹硫平40例(6.3%)。共54例(8.8%)患者使用心境稳定剂,使用频率居前三位的分别为丙戊酸镁26例(48.1%),丙戊酸钠19例(35.2%),卡马西平9例(16.7%)。共222例(36.0%)患者使用抗焦虑和镇静催眠药物,其中苯二氮艹卓类药物中使用氯硝西泮74例(33.3%),其次为阿普唑仑61例(27.5%)、艾司唑仑30例(13.5%)。在躯体疾病辅助用药中,心脑血管疾病药、降糖药、保肝药物使用例数分别为468例(76.0%)、123例(20.0%)、73例(11.9%)。结论精神病院住院患者中非典型抗精神病药的使用占主导地位,且符合单一用药原则,药物使用剂量合理,但应控制苯二氮艹卓类药物的使用。     

Use of atypical antipsychotics in a Veterans Affairs hospital

In a retrospective chart review, efficacy and drug costs were compared in 91 consecutive outpatients receiving risperidone (n=70) or olanzapine (n=21) at the Veterans Affairs Medical Center in Syracuse, NY. Between-group differences in background characteristics, diagnoses (schizophrenia in more than half of each group) and antipsychotic efficacy [Clinical Global Impressions (CGI) scale scores] were not significant. The mean doses were 3.6+/-2.4 mg/day of risperidone and 10.7+/-7.6 mg/day of olanzapine. The VA costs of these mean doses were S3.32/day for risperidone and $6.67/day for olanzapine. Mean duration of treatment was significantly longer for risperidone (21 months) than for olanzapine (13 months). Incidence of parkinsonian symptoms (14% of both risperidone and olanzapine patients) and tardive dyskinesia (3% of risperidone patients and 5% of olanzapine patients) was similar in the two groups. Akathisia tended to occur more often in patients receiving olanzapine than risperidone (14% versus 3%, P=.08). The results of this retrospective survey indicate that, in comparable VA populations of patients with psychotic and other disorders, risperidone and olanzapine are equally efficacious but olanzapine may be more likely to produce akathisia and is twice as expensive as risperidone.     

利他林、毒扁豆碱治疗精神药物急性中毒临床对比观察

目的 研究利他林与毒扁豆碱抢救精神药物急性中毒的疗效。方法 对41例精神药物急性中毒患者进行随机分组,分别利用毒扁豆碱和利他林治疗,观察疗效和副反应。结果 利他林组20例抢救成功,成功率100％;平均清醒时间为13．26小时;毒扁豆碱组21例中死亡1例,成功20例,成功率为95．24％,平均清醒时间为11．69小时。结论 利他林和毒扁豆碱对急性精神药物均有较好的疗效,二者无显著性差异。但利他林副作用小,安全性更高。     

Effectiveness of atypical antipsychotics for substance use in schizophrenia patients

OBJECTIVE: This study examined the influence of medication class (atypical antipsychotic, typical antipsychotic and no medication) and compliance on substance use outcomes for schizophrenia patients in the community. METHOD: N=362 adults with schizophrenia-spectrum disorder were followed for 3 years in a naturalistic study with structured interviews at 6-month intervals. Multivariable time-series analysis was performed using propensity-score adjustment for selection to medication class. RESULTS: Participants who were compliant with atypical antipsychotic medications for 90 days or more during each 6-month period were significantly less likely to use substances during the next 6-month period than patients who were compliant with typical antipsychotics or those who were not prescribed either type of medication for at least 90 days. CONCLUSION: Atypical antipsychotics may offer an advantage in reducing substance use among schizophrenia patients. For patients to benefit from atypical antipsychotics, treatment should focus on enhancing compliance and integrating substance use treatment.     

The use of atypical antipsychotics in nursing homes

BACKGROUND: Use of atypical antipsychotics for "off-label" indications, such as behavioral and psychological symptoms of dementia, depression, and bipolar disorder, have been frequently reported, although not systematically studied. We describe the pattern of atypical antipsychotic use among nursing home residents and identify demographic and clinical correlates. METHOD: We conducted a cross-sectional study on 139,714 nursing home residents living in 1732 nursing homes in 5 U.S. states from Jan. 1, 1999, to Jan. 31, 2000. Data were obtained from the computerized Minimum Data Set (MDS) assessment records. RESULTS: Behavior problems associated with cognitive impairment were manifest in 86,514 residents, and, of these, 18.2% received an antipsychotic. Approximately 11% received an atypical antipsychotic, while 6.8% received a conventional agent. Clinical correlates of atypical antipsychotic use were Parkinson's disease (adjusted odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.34 to 1.84), depression (OR = 1.35, 95% CI = 1.24 to 1.46), antidepressant use (OR = 1.38, 95% CI = 1.27 to 1.49), Alzheimer's disease (OR = 1.21, 95% CI = 1.12 to 1.32), non-Alzheimer dementia (OR = 1.15, 95% CI = 1.07 to 1.24), and cholinesterase inhibitor use (OR = 1.74, 95% CI = 1.52 to 1.98). Severe functional impairment was inversely related to atypical antipsychotic use (OR = 0.76, 95% CI = 0.65 to 0.89). CONCLUSION: Atypical antipsychotics are now used more than conventional antipsychotic agents in U.S. nursing homes. Indications and dosages seem appropriate relative to labeling. Clinical and demographic differences between atypical and conventional antipsychotic users tend to be relatively small, suggesting that other factors may explain the choice of prescribing physicians. The impact of facility factors, economic forces, and physician characteristics needs to be investigated.     

Emerging evidence for the use of atypical antipsychotics in borderline personality disorder

BACKGROUND: The availability of new atypical antipsychotics provides new opportunities for the treatment of borderline personality disorder (BPD). METHODS: Original papers on this topic were sought. Our study reviewed and discussed 14 papers. RESULTS: 2 RCTs, 4 non-controlled open-label studies and 8 case reports. The patient populations studied were highly diverse and the dropout rate after a long follow-up period was high. All of the articles reported positive effects of olanzapine, clozapine, quetiapine and risperidone. CONCLUSION: BPD patients with psychotic-like, impulsive or suicidal symptoms might benefit from atypical antipsychotics. Since the methodological quality of the reviewed articles is poor, further randomised placebo-controlled studies with longer follow-ups are needed before any firm conclusions can be drawn.     

Off-label use of antipsychotics and associated factors in community living older adults*

Background: Given the common off-label use of antipsychotics (AP), we aimed to assess the factors associated with this use in community living older adults.

Methods: The study sample consisted of a large representative sample of older adults (n = 4108), covered under a public drug insurance plan in Canada. Off-label use of antipsychotics was defined by the absence of an approved indication for this use, according to Health Canada's drug product database. Multinomial logistic regression was used to assess the factors associated with off-label use.

Results: The prevalence of antipsychotics use was 2.5%, of which 78% was off-label. Compared to non-use, off-label antipsychotics use was negatively associated with advanced age (≥75 vs. 65–74 years old) (OR: 0.46; 95%CI: 0.27–0.78); and positively associated with higher education level (OR: 2.68; 95% CI: 1.64–4.40), higher number of outpatient visits (≥6) (OR: 2.39; 95%CI: 1.34–4.25), antidepressant or benzodiazepine use (OR: 5.81; 95%CI: 3.31–10.21), and the presence of an organic brain syndrome & Alzheimer's (OR: 5.73; 95%CI: 1.74–18.89). Compared to labeled use, off-label use was less likely in those with major depression (OR: 0.02; 95%CI: <0.01–0.11) and with insomnia (OR: 0.13; 95%CI: 0.02–0.91).

Conclusions: The majority of antipsychotics prescribed to community living older adults were off-label. This off-label use was more likely in complex clinical cases with multiple outpatient visits and other psychotropic drugs use. Further research should focus on the long-term effects associated with off-label use of antipsychotics.     

The use of atypical antipsychotics in pediatric bipolar disorder

Diagnosis of bipolar disorder in children and adolescents is increasing, and the early-onset form of bipolar disorder usually carries more morbidity than later-onset forms. Patient education and psychotherapeutic and psychosocial interventions should be used in conjunction with carefully planned medication regimens. Recent data support the use of atypical antipsychotics for manic or mixed states in children and adolescents. However, more information is needed about long-term treatment of mania, treatment of bipolar depression, and treatment of comorbid psychiatric conditions.     

抗精神病药对慢性铝暴露痴呆模型大鼠学习记忆功能的影响

目的观察抗精神病药(antipsychotics,AP)对于慢性铝暴露痴呆模型大鼠学习记忆功能的影响,以及典型AP和非典型AP影响的区别。方法 30只慢性铝暴露痴呆模型大鼠,随机分为3组,每组10只。利培酮组给予利培酮0.20 mg/(kg·d)灌胃,氯丙嗪组给予氯丙嗪10 mg/(kg·d)灌胃,对照组给予生理盐水灌胃。8周后3组大鼠进行Morris水迷宫测试,评价学习和记忆功能。结果干预后,氯丙嗪组大鼠定向航行实验平均潜伏期[(24.8±1.6)s]长于利培酮组[(18.0±2.7)s]和对照组[(17.1±2.6)s],差异有统计学意义(P0.01),利培酮组与对照组之间无统计学差异(P0.05)。定向航行实验中3组使用搜索策略类型所占比例无统计学差异(P0.05)。空间搜索实验中,氯丙嗪组大鼠在站台放置象限内停留时间[(34.7±8.4)s]短于利培酮组[(44.6±5.5)s]和对照组[(47.9±6.2)s],差异有统计学意义(P0.01),利培酮组与对照组之间无统计学差异(P0.05)。氯丙嗪组大鼠穿越站台次数(6.0±2.2)少于利培酮组(8.6±2.8)和对照组(8.7±2.8),差异有统计学意义(P0.05),利培酮组与对照组之间无统计学差异(P0.05)。结论该模型中经典和非经典AP均不能改善痴呆模型大鼠的学习记忆功能,经典AP对大鼠的学习记忆功能造成负面影响,而非经典AP则没有明显负面影响。     

The use of atypical antipsychotics in the treatment of catatonia.

PURPOSE: Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia. MATERIALS AND METHODS: A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004. RESULTS: The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics. CONCLUSION: There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.     

改良电休克联合抗精神病药物治疗女性难治性精神分裂症的疗效对比观察

目的探讨改良电休克（MECT）联合抗精神病药物治疗女性难治性精神分裂症的临床疗效和安全性。方法40例女性难治性精神分裂症患者白药物治疗第2周起联合MECT治疗8周。采用阳性与阴性症状量表（PANSS）和治疗时出现的症状量表（TESS）评定疗效和不良反应,采用韦氏记忆量表（WMS）评定MECT对记忆的影响。结果MECT治疗后第2、4、8周末PANSS评分明显降低。WMS评分在治疗结束后1d明显降低,1周及2周时恢复。第8周末总有效率为85％。结论MECT联合抗精神病药物治疗女性难治性精神分裂症的疗效显著,不良反应少,虽对记忆力有一定影响,但是短暂的,可逆的。     

Study on the efficacy and tolerability of amisulpride in medical/surgical inpatients with delirium admitted to a general hospital

PurposeTo evaluate the efficacy and safety of amisulpride in medical inpatients who present with delirium.MethodOpen label prospective study with 7-day follow-up. Forty hospital inpatients with delirium were recruited, seven of whom died and two of whom refused medication. The average dose of amisulpride for delirium treatment was 200–300 mg/day. Daily assessments were performed with Delirium Rating Scale (DRS), Positive Subscale of the Positive and Negative Syndrome Scale (PANSS-P), Mini Mental State Examination (MMSE), Neurological Subscale of the UKU side effect rating scale. Variance analysis was performed through repeated measurements, with the general linear model with paired comparisons and Bonferroni correction for each measured variable.ResultsPatients showed significant improvement on the DRS from the first day of treatment DRS = 17.55 until day 7 DRS = 7.26 (F = 92.485; p < 0.001), psychotic symptoms improved from first day PANSS-P = 18.26 to last day PANSS-P = 9.35 (F = 144.83; p < 0.001). Cognitive status showed a significant improvement from day 2 MMSE = 18.71 until day 7 MMSE = 24.06 (F = 96.56; p < 0.001), and the neurological subscale of the UKU side effect rating scale showed a significant improvement the last day with respect to baseline pretreatment level (F = 7.539; p = 0.01).ConclusionsThese results suggest a good response to amisulpride in the acute phase of delirium, although further randomized controlled studies must be performed.