抗精神病药长效针剂治疗精神分裂症的专家共识

精神分裂症是一种慢性、高复发性和高致残性疾病,预防复发是治疗过程中的关键。国内外治疗指南中推荐抗精神病药长效针剂为预防复发的重要治疗策略之一,并且目前已积累一定的研究数据。由于治疗指南更新的相对滞后,针对长效针剂的实际临床应用尚不能及时在指南中全面体现。基于此,在中华医学会精神医学分会精神分裂症协作组的组织下,由15位精神科专家组成了本共识的专家组,在系统总结长效针剂在精神分裂症全程治疗中的疗效和安全性数据基础上,针对临床实践者最关注的长效针剂实际临床应用问题,包括适用患者人群、用法用量、临床应用、常见不良反应及处理、特殊人群使用以及使用全程中的医患沟通要点给予了合理阐述,以期帮助医生在实践中规范合理地应用以改善患者的治疗及预后。     

抗精神病药长效针剂在精神分裂症治疗中的作用

精神分裂症是一种慢性、复发性、致残性疾病,在治疗中预防复发是治疗的关键。而抗精神病药长效针剂是预防复发的重要治疗策略之一,由于长效针剂的剂型特点,随机对照研究的设计有一定难度且研究观察期较长,指南的更新也相对滞后,可能会影响其临床的应用。基于此,由中华医学会精神医学分会精神分裂症协作组发起,组织了国内15位精神科专家成立专家组,进行系统文献检索及梳理,总结抗精神病药长效针剂的疗效和安全性数据,对其在精神分裂症患者治疗中的作用进行汇总分析,希望为临床医生选择治疗药物提供重要的研究数据。     

长效抗精神病针剂的临床运用

本介绍长效精神病针剂治疗的基本原理和应用规则。     

精神分裂症患者使用长效抗精神病药物的现况调查

目的了解国内精神分裂症患者长效抗精神病药物(DAP)的使用现状。方法按一定的抽样比例,选择10个省市46家专科医院或综合医院精神科,对4779例门诊和住院精神分裂症患者进行药物使用情况的调查。结果①在4779例患者中,312例(6.5%)使用DAP治疗,按使用频率依次为氟哌啶醇癸酸酯(37.8%)、氟奋乃静癸酸酯(25.6%)、哌普噻嗪棕榈酸酯注射剂(19.9%)和口服五氟利多(16.7%)。②使用DAP者较未使用者平均年龄大、病程较长,前者联合用药79.8%(249/312)和合并使用抗胆碱能药物38.5%(120/312),高于后者,上述差异均有统计学意义(P<0.001)。合用药物以氯氮平最常见,占41.3%(129/249);③DAP治疗期间患者出现不良反应的发生率78.8%(246/312),主要是锥体外系不良反应。影响选择DAP治疗的因素包括患者的病程及症状表现。结论精神分裂症患者使用DAP治疗的比例较低,受患者病程及症状表现影响,多为联合用药。     

新型抗精神病药治疗精神分裂症的研究进展

抗精神病药是治疗精神分裂症最广泛使用的药物,各种抗精神病药优缺点不尽相同.故本文通过查阅相关文献及资料,对一些新型抗精神病药进行综述,从而为广大临床一线医生优化用药提供指导.     

精神分裂症住院患者使用抗精神病药现状

目的：调查精神分裂症住院患者抗精神病药使用现状。方法：样本采取整群入组,横断面调查方法．符合国际疾病分类第10版精神分裂症诊断标准的患者,共503例,调查其用药情况。结果：临床药物治疗以单一用药为主(占90．9％),氯氮平使用比例较高(占30．2％);首次发病及病程短于5年的患者使用新型抗精神病药相对较多(分别为20．7％及31．5％)。结论：传统抗精神病药物仍为目前的主流治疗药,使用新型抗精神病药所占比例远低于发达国家。临床医生在选择氯氮平时,对躯体情况缺乏关注。     

抗精神病药与精神分裂症认知功能

本文综述了精神分裂症存在的主要认知缺陷,测试方法和抗精神病药对精神分裂症认知功能的影响。认知功能缺陷是克雷丕林所描述精神分裂症的核心特征,且不能由精神症状等精神病理学解释。精神分裂症的认知缺陷主要包括注意障碍、记忆障碍、抽象思维障碍和信息整合障碍４个方面。注意障碍包括听觉和视觉注意障碍,是引起病人信息加工困难的主要原因。注意障碍又可分注意分散和监控性注意障碍,注意专注和转移困难,选择性注意障碍和警觉性降低。记忆障碍一般是广泛性的,涉及记忆系统的各个部分。精神分裂症的记忆缺陷可表现为故事的复述,言…     

抗精神病药治疗精神分裂症导致静坐不能的预测

为了探讨精神病药治疗精神分裂症导致静坐会不能的发生率４主临床预测因素，作者对２４２例精神分裂症患者进行研究，结果发现静坐不能发生率为２１．４９％，年龄小，使用高效价抗精神病药，药量较大的患者发生静坐不能的危险性大，而静坐不能的发生与性别，病情严重程度无关。     

住院精神分裂症患者抗精神病药使用情况比较

为了解我院精神分裂症住院患者抗精神病药（APD）10年前后使用变迁状况,对不同年代的用药进行了调查,现将结果分析如下.     

精神分裂症、抗精神病药与糖尿病

近年来,糖尿病已成为一个严重的公共卫生问题,而很早已发现精神分裂症患者的葡萄糖调节异常较正常人群为高,如Braceland(1945)等就发现精神分裂症有葡萄糖调节异常现象;近期的研究也发现精神分裂症发生血糖调节异常及糖尿病患者更为常见,如美国成年人2型糖尿病患病率约为3％,而精神分裂症患者约为前者的2—3倍以上,甚至达     

Effects of acute paliperidone palmitate treatment in subjects with schizophrenia recently treated with oral risperidone

Objective

To examine efficacy and safety of acute treatment with paliperidone palmitate in subjects with schizophrenia whose disease remained symptomatic despite recent treatment with oral risperidone.

Methods

Post hoc analysis of a 13-week, double-blind, placebo-controlled study of subjects with symptomatic schizophrenia randomized to paliperidone palmitate 39, 156, or 234 mg (25, 100, or 150 mg equivalents of paliperidone) or placebo. Paliperidone palmitate subjects received a 234-mg day 1 dose, followed by their assigned dose on day 8 and monthly thereafter. Subjects treated with oral risperidone within 2 weeks before randomization regardless of duration were included. Assessments: PANSS, CGI-S, PSP scores; AEs. ANCOVA models with LOCF methodology evaluated treatment group differences.

Results

216 subjects received prior oral risperidone (paliperidone palmitate 39 mg, n = 53; 156 mg, n = 58; 234 mg, n = 48; placebo, n = 57). Median prior risperidone use was 22 days. Significant improvement was observed with paliperidone palmitate 156-mg or 234-mg versus placebo in least-squares mean (SE) score change at end point in PANSS total (156 mg, −15.8 [3.0], p = 0.0001; 234 mg, −17.6 [3.2], p = 0.0001), CGI-S (156 mg, −0.9 [0.2], p = 0.0068; 234 mg, −1.1 [0.2], p = 0.0003), and PSP (156 mg, 10.7 [2.3], p = 0.0061; 234 mg, 12.9 [2.4], p = 0.0009). Most common AEs (≥ 10%) in any paliperidone palmitate group were insomnia, anxiety, and headache.

Conclusions

In subjects with schizophrenia who recently received oral risperidone but who remained symptomatic, acute treatment with monthly doses of 156-mg and 234-mg paliperidone palmitate significantly improved clinical symptoms, global illness ratings, and functioning compared with placebo, with no unexpected safety findings.     

注射用利培酮微球治疗精神分裂症的疗效和安全性研究

目的 评估注射用利培酮微球(LAIR)对中国人群治疗精神分裂症的疗效和安全性.方法 采用前瞻性、开放、多中心研究方法,对251例符合美国精神障碍诊断与统计手册第4版诊断标准的精神分裂症患者进行LAIR治疗,每2周注射1次,观察期为12周.分别在基线和治疗第4,6,8,12周末进行阳性和阴性症状量表(PANSS)评分、临床总体印象量表评分等,并记录治疗中的不良事件.结果 治疗4周后,PANSS评分均较治疗前持续下降(P<0.01);而病程≤2年患者的PANSS总分[(28.01±24.74)分]降低程度显著优于病程>2年者[(22.34±20.46)分];P<0.01.治疗第4周末,临床总体印象量表-严重程度(CGI-S)评分较基线显著降低(P<0.01).总体不良事件发生率为12.4%,多为轻、中度不良事件.结论 LAIR治疗精神分裂症安全、有效,对病程较短者疗效更好.     

Expert consensus on pharmacotherapy for tic disorders in Japan

Objective

We aimed to clarify the current status of pharmacotherapy for tic disorders and comorbidities in Japan. We used a systematic survey to collate the consensus of Japanese experts and compare it with the recent international evidence.

注射用利培酮微球与口服利培酮对精神分裂症血浆催乳素及社会功能的影响

目的比较两种不同剂型的利培酮（注射用长效利培酮微球与口服利培酮）对精神分裂症患者血浆催乳素及社会功能的影响。方法 74例口服利培酮≤4mg/d达6周且病情稳定的门诊精神分裂症患者,被随机分为注射长效利培酮微球组（注射组,利培酮剂量每2周为25～50mg）和口服利培酮组（口服组,利培酮剂量≤4mg/d）。于分组前及分组后4周、8周、16周检测患者的血浆催乳素水平,于分组前和分组后8周、16周以个人和社会功能量表（Personal and Social Performance,PSP）评定患者的社会功能,以阳性和阴性症状量表（PANSS）、临床疗效总评量表中的病情严重程度（GGI-SI）及Simpson锥体外系副反应评定量表（SEPS）评定疗效和不良反应。结果注射组37例患者中,有30例（82.1%）完成研究,口服组37例患者中,有32例（85.7%）完成研究,将完成全部研究的患者的资料纳入统计分析。分组前两组的PNASS、CGI-SI及SEPS评分比较均无统计学差异。分组治疗16周后,两组的PANSS评分及CGI-SI评分均下降,但两组间比较无统计学差异;注射组、口服组的SEPS评分的均数（标准差）为3.7（2.5）和5.1（2.8）,（t=2.12,P=0.037）。分组治疗8周后,注射组与口服组的血浆催乳素均数（标准差）分别为48.2（15.7）μg/L及54.2（18.8）μg/L,（t=2.59,P=0.012）,两组的PSP评分的均数（标准差）分别为70.9（9.7）及65.3（11.1）,（t=2.01,P=0.049）;分组16周后,注射组与口服组的血浆催乳素浓度的均数（标准差）分别为31.5（17.1）μg/L及58.5（16.8）μg/L,（t=6.24,P〈0.001）,两组的PSP评分的均数（标准差）分别为79.3（6.0）及66.1（9.6）,（t=6.44,P〈0.001）。两组血浆催乳素水平的差异有统计学意义（F=4.79,P=0.033）,两组PSP分值的差异有统计学意义（F=8.70,P=0.005）。结论与口服利培酮相比,注射长效利培酮微球后患者出现的锥体外系不良反应较轻,高催乳素血症的程度较低,社会功能恢复较好。     

Use of long-acting injectable risperidone before and throughout pregnancy in schizophrenia

Data on the use of long-acting injectable (LAI) risperidone, the first atypical depot antipsychotic, during pregnancy are limited. A 35-year-old woman with schizophrenia was given LAI risperidone before and throughout her pregnancy. She gave birth to a female infant weighing 2230 g at 36 weeks and 6 days of pregnancy, following premature rupture of the membranes. The baby had no congenital malformation and was healthy 8 months postnatal. To our knowledge, this is the first reported use of LAI risperidone throughout an entire pregnancy. In this paper, we discuss the rationale and problems of LAI risperidone use in pregnancy, based on a literature review.     

Second-generation long-acting injections anti-psychotics improve executive functions in patients with schizophrenia: a 12-month real-world study

Abstract

Background: The main purpose of this study was to assess possible modifications of cognitive performance among schizophrenia patients treated with long-acting injectable antipsychotics (LAIs) of second generation anti-psychotics (SGAs). Our hypothesis is that the shift from the oral formulation to the LAI formulation of SGAs drugs improves the cognitive performance. The secondary objective was to carry out a head to head comparison of two different SGA-LAI treatments [i.e., 1-month Paliperidone Palmitate (PP1M), monthly Aripiprazole (Ari-LAI)] in our study with an independent and real-world setting.

Methods: The sample comprised 32 participants who were consecutively recruited over 12?months. Seventeen patients treated with Ari-LAI and 10 treated with PP1M completed psychopathological, neuropsychological and functional assessments. Group differences were explored through chi-squared and t-tests, as appropriate. GLM Repeated Measures were used to study variations of cognitive performance along 12?months and to test differences between drugs.

Results: We found an effect of time on the outcomes investigated but this did not depend on the type of LAI used.

Conclusions: In comparison with the previous oral treatment with SGAs, patients showed a significant improvement in neurocognitive function after 12?months of treatment with SGA-LAI. Furthermore, there were no differences between the SGA-LAI regimens.

• Key points

• The main purpose of this study was to assess possible modification of cognitive performance of patients with Schizophrenia treated with second generation long-acting injectable antipsychotics (SGA-LAIs).

• The secondary objective was to carry out a head to head comparison of two different SGA-LAIs: Paliperidone Palmitate 1-Month (PP1M) and Aripiprazole Monthly (Ari-LAI).

• Patients showed a significant improvement in neurocognitive function after 12 months of treatment with SGA-LAI.

• There were no differences between the SGA-LAI regimens.

• From a practical point of view, switching to LAI formulation seems to produce further social and cognitive improvements in patients who had already benefitted from oral SGA therapy.

     

Expert Canadian consensus suggestions on the rational, clinical use of ziprasidone in the treatment of schizophrenia and related psychotic disorders

Many atypical antipsychotic medications are becoming available for clinical use. Ziprasidone is a recent addition to this group and is expected to become available for clinical use in Canada in 2005. Ziprasidone has some significant differences compared with other atypicals currently available in Canada. Clinicians need to understand the benefits and risks associated with each of the antipsychotic medications available for the treatment of schizophrenia and related psychotic disorders to ensure their most appropriate utilization. At the suggestion of Professor Stan Kutcher (chair) and as part of an ongoing commitment to provide independent education pertaining to the utility of new psychotropic compounds to health professionals, a panel of Canadian experts in the treatment of schizophrenia spectrum disorders was convened to provide consensus suggestions for the appropriate clinical use of ziprasidone. The consultations regarding the development of these recommendations were organized by Brainworks International (BWI) with arms-length funding from Pfizer Canada. This paper describes the experts' consensus views on the efficacy and safety of ziprasidone, their suggestions on which patients may be suitable for ziprasidone treatment, and how to initiate treatment (including how to switch from other antipsychotic medications), manage side effects, and monitor patients in long-term therapy. These suggestions are those of the authors only and are not endorsed by or necessarily reflect the opinions of BWI or Pfizer Canada.