非典型抗精神病药治疗精神分裂症的临床应用评价

,(,200030)R971+14A1672-2124(2005)02-0075-06:,:MedlinePubmedOvidScienceDirectProquest:10,,,,,;;;;;;ClinicalEvaluationofAtypicalAntipsychoticsintheTreatmentofSchizophreniaHUANGJizhong,ZHANGMingyuan(ShanghaiMentalHealthCenter,Shanghai200030)ABSTRACTOBJECTIVE:Tosystematicallyreviewtheaspectsofclinicalusageandresearchprogressofatypicalantipsychoticsinthetreatmentofschizophrenia(SP)andevaluatetheirclinicalefficacyandsafety.METHODS:TosearchmedicalliteraturesinresentyearsatMedline,Pubmed,Ovid,ScienceDirectandProquestbyinternetandsomereportspublishedonmedicalliteraturesathomeandabroadforananalysis.RESULTS&CONCLUSION:Clinicaluseandresearchofatypicalantipsychoticsinthetreatmentofschizophreniahavebeenwell-performedandtheadvancementshavebeenswift.Mostofnewtypeofatypicalantipsychotics,suchasrisperidone,olanzapine,quetiapine,ziprasidoneandaripiprazole,havealreadybecomethefirstlinechoiceforthetreatmentofschizophreniaindifferentlevel,differentstageandpreventionofrecurrence,exceptforclozapine.Inparticular,theyhaveobviouslyminimizedsideeffectscausedbyclassicantipsychoticsandclozapine.Variousclinicalresearchresultshavebeenconfirmedbymanyclinicallysystematicresearchestakingthemethodofevidence-basedpsychiatry.KEYWORDSatypicalantipsychotics;classicantipsychotics;schizophrenia;clinicaltrial;clinicalevaluation;evidence-basedpsychiatry;extrapyramidalsymptoms(EPSs),,1952,30,,(classicantipsychotics),D2,,(EPSs)EPSs60%,,50%,20%,,,EPSs,D2,5-(5-HT)(NE),(atypicalantipsychotics),D2[1],15,,(Risperidone)(Olanzapine)(Quetiapine)(Ziprasidone)(Amisulpiride)(Adpiprazolel),,50%1D2,D2,D2EPSs,--D2(PRL),20055275©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,D2,5-HT1A,2A,2C,3,6,7NE1,2,,,5-HT2AD2;;,EPSs,,D2,,[1,2],,(Zotepine),(Sertindole),,,,,EPSs,,[2,3]2,,(RCTs)(Meta),MedlinePubmedOvidScienceDirectProquest,,,,211(Clozapine),,,,[4,5]Kane7129,(35%vs67%),(57%vs25%),,2,[6],,,Hagg,,[7];Cohen,6018%,,,;(),,,2-,,200250mg/ml,80,,,,,,,,,212(Olanzapine),30520mg/d,,10mgPd,16(2000),1015mg(215mg)/d10mgPd,(155)mgPd,,,,,1,1,[810]Lindenmayer[11]43,40mg/d,,2040mgPd1617%118,2015mgPd30316mgPd,Conley[12]3778,1214mg/d,418mg/d,7712%7118%,,,8,PANSS/,EPSs,,Tran[13],,,11917%28%,(P=01034)Perry[14],,2312ngPml,,,EPSs,,,-;2,,,76Evaluationandanalysisofdrug2useinhospitalsofChina2005Vol.5No.2©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.;PRLLiebzeit[15],,,6,,,1656,520mg/d,80%,,,(3P65),,213(Quetiapine),,,,5-HT2,D1D2,M,,3h6h150750mg/d,800mg/d,,Purdon[16]256,6,EPSsCopolov[17]16,,,EPSsPRLEmesley[18]18RCT,,(PANSS)(BPRS),,EPSsPRL,,,,1,,4,,,,214(Risperidone),5-HTDA,5-HT2A/D2,,20h22h(9--),116mg/d,28mg/d,,,,,EPSs10mg/d20mg/d1(),6mg/d,EPSs60%,83%,EPSs,,[19]Kopala[20]24mg/d58mg/d,PANSS3,EPSs,,,24mg/d,Lane[21],6mgPd,60%,40%(316019)mg/d,,EPSs-,12mgPd,EPSsCsemansky[22]3971,,(34%/60%),EPSs,,Markianos[23]PRL,,PRL,PRL,PRL,,,,,EPSs,,(Path-analysis),,,,8,,,,,,,215(Ziprasidone)5-HT2A-D2,,5-HTNE5-HT1A,312h10h,80160mgPd,,,1,,1,,,3,,,EPSs,,20055277©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,EPSs[24,25],,,Q-Tc,1FDA,,Q-Tc2013ms,2988,2(0106%)Q-Tc(500ms),4401(0123%)Q-Tc500ms,Q-Tc,1,Q-Tc,Q-Tc,(Sotalol)(Sparfloxacin),,216(Sertindole),5-HT2A/D2-,3,,,1,16mg/d24mg/d10mg/d,8mg/d,EPSs,1,,,(-)Q-Tc,Pezawas[26]34,Q-Tc1917ms,EPSs,PRL,FDA,,,2,2002[2628]217(Amisulpiride),D2D3,,D2DA,DA,,,,(400800mg/d),BPRS540mg/d,25mg/d,,(50300mg/d),,5-HT2AD2EPSsEPSs-,EPSs,PRL,,PRL,;;[29],2001200mg/d,FDA,218(Zotepine),,,5-HTDAH1NE,NE,(TCAs),3d4d,75450mg/d,,150300mg/d1020mg/d,,EPSs;,BPRSEPSs;,16,Hwang[30],,6,70,,EPSs,[31],FDA,219(Aripiprazole),D2D3,D2D2,5-HT1A2A/C5-HT1A5-HT2A,D2,,D2-,-DA,44h70h,,1530mg/d,10mg/d,,D2EPSsPRL,,Potkin4044,20mg/d(n=101)30mgPd(n=101)(n=103)6mg/d(n=99),PANSS(CGI),,20mg/d30mgPd6mgPd,,EPSs,PRL,,5,Q-Tc,,P450,Pigott31026MeQuade129452,,,,,,78Evaluationandanalysisofdrug2useinhospitalsofChina2005Vol.5No.2©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,,[3134],2110,Volavka14,157,,,314,,,,,3014mg/d1114mg/d,,EPSs,[35]Davis(2003)1,12418,Hedges-Olkin,(LOCF),,,,0149012901250121,,P210-8310-7210-12310-9,,,,6(Ramoxipride),[36]Leucht(1999),,,,,,,EPSs[37]3,,,D2,,,,,,,,,:(1),;(2),;(3),,;(4),,;(5),,,,,,,PRLQ-Tc;(6),[1]KinonBJ,LiebermanJA.Mechanismsofactionofatypicalantipsychoticdrugs:acriticalanalysis[J].Psychopharma2cology,1996,124:2.[2]AnderssonC,ChakosM,MailmanR,etal.Emergingrolesfornovelantipsychoticmedicationsinthetreatmentofschizo2phreniz[J].PsychiatrClinnorthAm,1998,21:151.[3]LeysenJE,JanssenPMF,SchotteA,etal.Interactionofan2tipsychoticdrugswithneurotransmitterreceptorsitesinvitroandinvivoinrelationtopharmacologicalandclinicaleffects:roleof5HT2receptors[J].Psychopharmacology,1993,112:S40.[4]KaneJM,HonigfeldG,SingerJ,etal.Clozapineforthetreatment-resistantschizophrenic.Adouble-blindcompari2sonwithchlorpromazine[J].ArchGenPsychiatry,1988,45:789.[5]MeltzerHY,McGurkSR.Theeffectofclozapine,risperi2done,andolanzapineoncognitivefunctioninschizophrenia[J].SchizophrBull,1999,25:233.[6]RosenheckR,CramerJ,XuW,etal.Acomparisonofcloz2apineandhaloperidolinhospitalizedpati