国产奎硫平或利培酮合并碳酸锂治疗伴有精神病性症状的女性躁狂发作的对照研究

目的比较国产奎硫平和利培酮合并碳酸锂治疗伴有精神病性症状的女性躁狂发作的效果及安全性。方法以80例入院治疗,符合ICD-10伴有精神病性症状的躁狂发作标准,Bech-Rafaelsen躁狂量表（BRMS）评分≥16分,精神病阴性/阳性症状评定量表（PANSS）分≥60分的女性患者作为研究对象。随机分为两组,分别以碳酸锂合并奎硫平和利培酮治疗8周。采用BRMS、PANSS总分及因子分评定治疗前,治疗后2、4、8周减分差异。疗效按治疗8周时减分率评定,以痊愈＋显效作为有效率评价。用副反应量表（TESS）评定治疗过程中的不良反应发生率。结果两组各40例均完成8周治疗,使用碳酸锂（1.2±0.3）g/d和（1.33±0.24）g/d。奎硫平组剂量（500±150）mg/d,利培酮组剂量（4.2±1.5）mg/d。8周有效率为72.5%和80%,两组疗效经Ridit分析,P=0.59。治疗2周后两组BRMS、PANSS总分及因子分均呈现同步下降趋势,但8周时利培酮组PANSS阴性症状因子分明显高于奎硫平组（P=0.03）。TESS评定中两组均有头晕、头痛、恶心、呕吐、便秘、心动过速、体重增加等现象。但奎硫平组更多出现困倦嗜睡,利培酮组则以静坐不能、肌张力增高,特别是催乳素增高率显著（P〈0.05~0.01）。结论奎硫平虽有困倦嗜睡,但较少引起锥体外系反应和高催乳素血症。因此从治疗风险/效益比评价,奎硫平较利培酮更适合于伴有精神病性症状的女性躁狂症,特别是年青女性的治疗。

A control study between domestic quetiapine and risperidone combine with lithium in the treatment of female manic episode with psychotic symptoms

Objective To explore the efficacy and safety between domestic quetiapine and risperidone combined with lithium in the treatment of female manic episode with psychotic symptoms.Methods A total of 80 female manic episode patients with psychotic symptoms by ICD-10（BPRS≥16,PANSS≥60） were randomly divided into quetiapine combined with lithium group and risperidone combined with lithium group to treat for 8 weeks.BechRafaelsen Mania Rating Scale（BRMS）,Positive and Negative Syndrome Scale（PANSS） and Treatment Emergent Symptom Scale（TESS） were used to assess the efficacy and side effects before and after 2,4,8weeks in the treatment.Results All of the patients completed the 8 weeks treatment,the use of lithium carbonate（1.2 ± 0.3） g / day and（1.33 ± 0.24） g / day.Quetiapine dose（500 ± 150） mg / day,and risperidone dose（4.2 ± 1.5） mg / day.The effective rate after 8 weeks were 72.5% and 80%,by Ridit efficacy analysis,P= 0.59.After 2 weeks of treatment the BRMS,PANSS total scores and factor scores both showed a downward trend in sync,but after 8 weeks,the PANSS negative symptom factor scores in risperidone group were significantly higher than the quetiapine group（P= 0.03）.Assessed by the TESS both of the two groups had dizziness,headache,nausea,vomiting,constipation,tachycardia,weight gain and so on,but more often quetiapine group brought drowsiness,and risperidone group brought akathisia,increased muscular tension,especially prolactin increased significantly（P0.05～0.01）.Conclusion Although there were more sleepy in the quetiapine group,but less likely to cause extra pyramidal reactions and hyperprolactinemia.Therefore,from treatment of risk / benefit ratio evaluation of quetiapine compared with risperidone is more suitable for women with psychotic symptoms of mania,especially in the treatment of young women.