利培酮治疗儿童青少年精神分裂症的临床疗效观察

目的观察儿童青少年精神分裂症患者服用利培酮后的临床疗效及不良反应。方法共收集符合DSM-Ⅳ诊断标准的精神分裂症患者89例(男43例,女46例),服用利培酮2-8 mg/d,治疗8周,分别在基线及治疗第2,4,6,8周末用阳性和阴性症状量表(PANSS)来评定疗效,用副反应量表(TESS)来评定不良反应。结果①治疗8周后PANSS减分率为65.1%,第2,4,6,8周末的PANSS总分与基线相比较有显著性降低(P<0.01);②锥体外系副反应在第4周末达到峰值57.3%,第8周末下降为43.2%。③利培酮剂量与PANSS呈负相关(2周末P<0.05,4周末P<0.01),利培酮剂量与锥体外系反应呈正相关(2周末P<0.01,4周末P<0.05),每2周体重增加与治疗时间正相关(P<0.01);④患儿的年龄、病程与临床疗效(第8周末PANSS减分率)存在一定关系(R2=0.150,年龄b=0.362,P=0.001;病程b=-0.254,P=0.031)。结论①利培酮治疗儿童青少年精神分裂症有效。②治疗前4周中小剂量的利培酮有助于改善病情,减少锥体外系反应。③患儿的年龄越小、病程越长,其疗效越差。

Observation on clinical efficacy of risperidone in treatment of children and adolescents with schizophrenia

Objective To assess the efficacy and adverse responses of risperidone for schizophrenia in children and adolescents patients.Methods A total of 89 patients(43 male and 46 female) met the DSM-Ⅳ criteria for schizophrenia.All patients were given risperidone 2-8 mg/d for 8 weeks.Patients were assessed by positive and negative syndrome scale(PANSS) and treatment emergent symptom scale(TESS) at the baseline and the end of 2nd,4th,6th and 8th week.Results ①Compared to the baseline,the PANSS total score decreased significantly at the end of 2nd,4th,6th and 8th week(P<0.01).After 8-week treatment,the reduction rate of PANSS was 65.1%.②The frequency of extrapyramidal symptom was up to 57.3% at the end of 4th week and dropped to 43.2% at the end of 8th week.③ The dose of risperidone was negatively correlated with the reduction rate of PANSS at the end of 2nd week(P<0.05) and 4th week(P<0.01),but positively correlated with extrapyramidal symptom at the end of 2nd week(P<0.01) and 4th week(P<0.05).There was a positive correlation between weight gain every two weeks and treatment time(P<0.01).④ Age and duration of disease affected the clinical efficacy by resperidone for children and adolescents with schizophrenia(R2=0.150,age b=0.362,P=0.001,disease duration b=-0.254,P=0.031).Conclusion ①Risperidone is effective in the treatment of children and adolescents with schizophrenia.②In the first 4 weeks of treatment,the low dose of risperidone can help children and adolescents patients improve the psychotic symptoms and reduce the extrapyramidal responses.③The younger children and the longer duration of illness is,the worse efficacy is.