精神药物性别差异

12009662•••3•+=•=•=LHPRL4••11%T1/210-2915%31-49••5•••••6•••••••7-1•••/•••2••8-2••••9-3•DA•••10Alpha-11••--•••GnRHLHFSH•12••••••••13•––––••14,15•–––pH4±–•16•PRL––•PRL17•61225••18•••98(17,33,46,2,1),4•98,519•••804060••18-2930-4142-53•E2LH200820•,•,•:,,,,.2007/03,21•:,•5-HT:5-HT•:•:2007/03,22•sexdifference,controlledstudy,depression,antidepressant,patient•Pubmed42papers23BMI,sex,andantidepressantresponse:SSRIsBMI(bodymassindex):274BMI30BMI30II-IV,HAMD-17MADRSJAffectDisord2007,99(1-3):101-6KhanA,etal24BMI,sex,andantidepressantresponse:,HAMD-17(non-obese,F=5.29,p=0.024;obese,F=7.04,p=0.012),MADRS(non-obese,F=4.09,p=0.048;obese,F=8.63,p=0.007),\\BMI:SSRIJAffectDisord2007,99(1-3):101-6KhanA,etal25•7•,18DSM-IV,1999,2,1—2002,11,27•HAMD-17,CGI-S,VAS,QLDS,PGI•Duloxetine40-120mg/dM=318,W=578•PlaceboM=242,W=484PGI=patientglobalimprovementscale,VAS=visualanalogscale,OLDS=qualityoflifeindepressionscaleJClinPsychiatry2006,67(5):761-70.KornsteinSGetal.26•HAMD-17,CGI-S,PGI.•(robustresponse)•VAS,••18.6%,13.5%•,,,,\\•,3JClinPsychiatry2006,67(5):761-70.KornsteinSGetal.JAffectDisord,2006,94(1-3):183-927:141(68,73),DSM-IV,HAMD-17/SF/SexFX/IRSD-F,bupropionsustainedrelease(SR)150-300mg/dparoxetine20-40mg/dCanJPsychiatry,2006,51(4):234-42.kennedySH,etalSF=sexfunction,SexFX=sexeffectsscale,IRSD-F=investigator-ratedsexualdesireandfunctionscale28:.paroxetine,bupropion,CanJPsychiatry,2006,51(4):234-42.kennedySH,etal29VenlafaxinevsSSRIs::8,Venlafaxine=851,SSRIs=748,=446.(remission)=HAMD7:Venlafaxine,;SSRIs:,JWomensHealth,2005,14(7):609-16.ThaseME,etal30?:292(96,196)3,DSM-IIIDSM-III-R,clomipramine150mg/d,citalopram40mg/d,paroxetine30mg/d,moclobemide400mg/d,HAMD-17.111clomipramineAmJPsychiatry,2003,160(9):1643-50.HildebrandtMG,etal31?:clomipramine,clomipramineclomipramineHAMD,AmJPsychiatry,2003,160(9):1643-50.HildebrandtMG,etal32?::1748,18-65,\MAOI\\:50,MAOI,:65AmJPsychiatry,2002,159(11)1848-54.QuitkinFM,etal.33:1056:HAMD-17(fluoxetine-17.8,maprotiline-13.9,P=0.017),44(fluoxetine-18.4,maprotiline-12.9,P=0.023),EurNeuropsychopharmacol.2001,11(3):227-32.MartenviF,etal34•-2008/02•-2003/02•,-,,1996/0335•CYP1A2••76%VS35%•QTCEPS20080236:\\:30(10,10),20-41,.58(3614,2210),16-53.BPRS,SAPS,SANSS.,,1996/0337:1.K(0.08vs0.05,0.05),T1/2(9.2vs13.8,13.3),Cmax(303vs552,757)(210vs386,404)P0.012.,Cmax(552vs757)(386vs404)NS3.\\,,1996/0338•1996-1---1999-4;1019(508,511)•:28.810.6,32.013.3,P0.05•:58.4%,64.8%,P0.05•,,•ECT2003/0239625.4439.920455.9184ECT13.880.9854.92514.1120.910712610.729.8508.1410.67562865326971.0920.910746.123411.293718927137PX22003/024062003/020.9331.89.738.314.7**6.808288.741.612.32.81230.78.639.5151.915905286.9838199.82.4222433.9129.5287.9126.35.918271.4142.9401.7176.1PtxS(mg)xS(mg)414.17.83611.7390.048.3311.970.0016.7618.611+7.0952.81923.514+4.3622.2845.527+Pt2003/0242,•112,\\\8•\,(IRI),(triglceride)•BMI,,IRI,•JClinPsycopharmacol,2007,27(4):374-9.WuRR,etal.43Sexselectionbiasinschizophreniaantipsychotictrials•Risperidone,olanzapine,quetiapine,ziprasidoneandaripiprazolerandomizedcontrolledtrials67publishedpapers•33.3%women(6.7%-71.2%)•ZiprasidonetrialsJClinpsychopharmacol2006,26(5):489-94,ChavesAC,etal44••,•[1]•DSM-IV328•HD+E,PANSSHD[2]1.ActaPsychiatrScandSuppl,2000,407:58-62.Riecher-RosslerA,etal2.ProgNeuropsychopharmacolBiolPsychiatry,2003,27(6):1007-12.AkhondzadehS,etal45•UK,Italy,Netherlands,Germany245manand164women•LiverpoolUniversityNeurolepticSideEffectRatingScale•,,,50%,70%•EPS,•,.JClinpsychopharmacol2005,25(6):521-6BarbuiCetal46:()841(259,582),1884(554,1330)6(amenorrhea,galactorrheaanddecreasedlibidoinwomen;erectile,ejaculatorydysfunction,gynecomastiaanddecreasedlibidoinmen)JClinpsychopharmacol1999,19(1):57-61,KleinbergDL,etal47:,,4-10mg/d.JClinpsychopharmacol1999,19(1):57-61.KleinbergDL,etal48TD•76TD1989•39,18724.2%,26.6%21.6%•50-70,70•TD••TD,SchizophrBull,1992,18(4):701-15.Yassar,etal49