托吡酯对氯氮平所致体质量增加干预的研究

目的探讨托吡酯辅助治疗氯氮平所致体质量增加的疗效和安全性。方法采用前瞻性平行对照方法共纳入72例稳定服用治疗剂量或维持剂量的氯氮平患者,随机分为2组,研究组合并托吡酯治疗,对照组单用氯氮平治疗。观察治疗6个月,定期测体重、腰围、血糖、血脂、心电图、脑电图、肝功能氯氮平血药浓度、血常规、UKU不良反应量表。对2组的临床资料进行比较。结果 14例因经济原因中途脱落,研究组脱落9例,对照组脱落5例,实际完成58例,研究组27例,对照组31例,研究组在第2月末体重、体质量较基线减轻明显,差异有统计学意义（P〈0.01）;第6月末体重、体质量进一步减轻,差异有统计学意义（P〈0.01）。2组体重比较,在基线,1月末、2月末、3月末、4月末差异均无统计学意义（P〉0.05）,在第5月末开始差异有统计学意义（P〈0.05）,第6月末差异更明显（P〈0.05）;2组体质量比较,在基线,1月末、2月末、3月末差异均无统计学意义（P〉0.05）,在第4月差异有统计学意义（P〈0.01）,本实验结束时即第6月末差异更明显（P〈0.01）。研究组UKU不良反应量表评分2组差异无统计学意义（P〉0.05）。结论托吡酯辅助治疗氯氮平所致体质量增加的疗效好和安全性高。     

第2代抗精神病药物成本-效果的循证评价

目的:为临床抗精神病药物合理应用提供依据。方法:采用循证医学和药物经济学相结合的方法对第2代抗精神病药物的成本-效果进行评价。结果:氯氮平、利培酮、奥氮平和喹硫平的成本-效果比分别为148·7、9192·5、23838·6、—4555·8元。结论:第2代抗精神病药物急性期药物经济学评价结果按成本-效果排序依次为氯氮平、利培酮、奥氮平和喹硫平。     

抗精神病药物引发精神分裂症患者糖尿病分析

随着非经典抗精神病药在临床的广泛应用，精神分裂症患者的糖尿病的患病率的增加，日益受到关注。糖尿病是一种常见的糖代谢紊乱为主的内分泌代谢病，严重地影响着患者的身心健康。本文介绍抗精神病药物引发精神分裂症患者并发糖尿病分析。     

抗精神病药物对精神分裂症患者体质量的影响与护理

目的分析抗精神病药物对精神分裂症患者体质量的影响与护理。方法选取我院2015年1月至2016年1月收治的精神分裂症患者64例,随机分为实验组和对照组,每组32例。两组患者均服用相同药物,对照组患者给予常规的一般护理,实验组患者采取护理干预,对比分析两组患者的体质量指数变化、体质量增加幅度。结果实验组患者经过护理后体质量指数(21.53±2.13)kg/m2,对照组患者护理后体质量指数(23.97±3.42)kg/m2,实验组患者体质量指数变化小于对照组患者,差异具有统计学意义(P<0.05)。结论抗精神病药物治疗精神分裂症配合护理干预能够降低患者的体质量增加幅度,患者治疗的依从性高,值得临床推广和应用。     

托吡酯治疗精神病患者激惹行为的临床对照研究

目的评价托吡酯治疗精神病患者冲动激惹行为的临床效果。方法将46例具有激惹行为的精神病住院患者随机分为两组,在原用药物不变的情况下,分别加用含托吡酯或不含托吡酯的胶囊治疗,采用修订的外显攻击量表(MOAS)和简明精神症状量表(BPRS)定期作盲式评定。结果加用托吡酯组控制冲动激惹行为的有效率为62.50%,明显高于对照组的31.82%(P<0.01),且未出现明显药物副作用。结论对具有激惹行为的精神病患者,可加用托吡酯以降低其激怒和冲动行为。     

盐城市第四人民医院住院老年精神分裂症患者抗精神病药物用药情况调查

目的分析盐城市第四人民医院住院老年精神分裂症患者抗精神药物使用情况,以期指导临床合理用药。方法回顾性分析2013年1月-2014年12月医院1061例老年抗精神药物使用情况,比较2年抗精神药物使用变化。结果 2年内联合用药比例分别是44.51%、43.23%,联合用药比例有所降低;从用药频率来看,目前主要抗精神药物是奥氮平(23.28%)、利培酮(20.45%)、喹硫平(17.15%)、阿立哌唑(7.72%),用药剂量分别为(13.4±2.2)mg/d、(2.6±0.6)mg/d、(345.5±43.4)mg/d、(11.5±2.1)mg/d。结论就目前来看,老年类抗精神药物单一用药还是占主导,且以非典型抗精神病药物为主,用药剂量均较小。     

住院老年精神分裂症患者抗精神病药物用药情况调查分析

目的:了解我院老年精神分裂症患者抗精神病药物使用情况.方法:对住我院84例住院老年精神分裂症患者使用抗精神病药物治疗情况进行调查.结果:单一用药76例,占90.48%,两种药物联用7例,占8.33%.按照单一药物应用频度排列前5位的是利培酮、氯氮平、奋乃静、喹硫平、氯丙嗪.结论:抗精神病药物使用多样化,剂量个体化.     

典型抗精神病药物与非典型抗精神病药物对精神分裂症患者心电图的影响

精神分裂症患者549例服用典型与非典型抗精神病药物,二者对心电图的影响报道如下。1资料与方法1.1临床资料2011年在我院住院的精神分裂症患者共549例,均符合中国精神疾病分类方案与诊断标准第3版(CCMD-3)和国际疾病分类第10版(ICD-10)中精神分裂症诊断标准。     

流浪精神分裂症患者抗精神病药物使用的性别差异

目的调查我院流浪精神分裂症患者抗精神病药物使用的性别差异。方法采用一日法,以2012年2月18日为时间节点,对我院流浪精神分裂症住院患者(男159例,女111例)的治疗情况进行对比研究。结果①单一使用抗精神病药物:占首位(男性为57.2%,女性为79.3%);联用两种以上抗精神病药物者男性为42.8%,女性为20.7%,男性明显多于女性,差异有统计学意义(P<0.001)。②男性使用抗精神病药物排在前3位的是:利培酮,氯丙嗪,舒必利;女性使用抗精神病药物排在前3位的是:利培酮,氯氮平,氯丙嗪;无重大剂量用药者。③抗精神病药物日均剂量折算为氯丙嗪剂量后,男性与女性比较差异无统计学意义(P>0.05)。结论本调查提示,目前,我院流浪精神分裂症患者抗精神病药物的使用情况比较规范合理,在联合用药方面及部分药物使用频度方面存在性别差异,日均剂量方面性别差异无统计学意义。     

住院精神分裂症患者抗精神病药物使用情况调查

目的 了解住院精神分裂症患者抗精神病药的使用情况,了解影响精神分裂症患者用药的因素.方法 采用横断面方法对住院精神分裂症患者使用药物的情况进行调查.结果 本次调查465例患者涉及47种药物治疗方案,使用1种抗精神病药物175例(37.6%),联用2种种抗精神病药物262例(56.3%),联用3种种抗精神病药物28例(6.0%),联用2种抗精神病药物治疗在住院患者中非常多见;氯氮平使用率和处方占有率排在第一,非典型抗精神病药物已占精神分裂症治疗用药的主导地位;公费医疗患者选择非典型抗精神病药物明显高于非公费医疗患者.结论 在精神分裂症治疗用药中,非典型抗精神病药物逐渐取代了典型抗精神病药物,并且患者费用支付方式影响抗精神病药物的选择.     

第二代抗精神病药物对精神分裂症患者心功能的影响

目的分析第二代抗精神病药物对精神分裂症患者心功能的影响及其不良反应。方法选取我院2011年1月至2013年12月诊治的精神分裂症患者100例,随机分为5组,分别为利培酮组20例,喹硫平组20例,奥氮平组20例,阿立哌唑组20例,齐拉西酮组20例。所有精神分裂症患者用药前及用药后1、2、3周均采用运动平板试验进行评估,治疗后的第1、2、3周分别进行B超、肝肾功能、血常规、血脂、血糖、水电解质、血清催乳素检查,并观察不良反应发生情况。结果喹硫平、奥氮平组患者体重增加及血糖升高例数多于其他组,喹硫平组患者心动过速例数多于其他组,利培酮组、喹硫平组、奥氮平组过度镇静例数多于其他组,差异均有统计学意义(P<0.05)。利培酮组(55%)、喹硫平组(65%)、奥氮平组(85%)不良反应发生率显著高于阿立哌唑组(30%)和齐拉西酮组(40%),差异有统计学意义(P<0.05)。五组患者用药3周后,运动平板试验阳性数、自我疲劳等级较用药前显著增高,达亚极量心率所需时间较用药前显著缩短,差异有统计学意义(P<0.05)。五组药物对精神分裂症患者心功能均有不同程度的影响,五组引起各种心血管不良反应发生率比较差异无统计学意义(P>0.05)。结论第二代抗精神病药物可以引起精神分裂症患者的心功能改变,齐拉西酮引起的QTc间期延长较突出,喹硫平可引发室上性心动过速、体位性低血压、心律失常等,利培酮、喹硫平、奥氮平引起不良反应较多,临床上应加以注意。     

Attenuating effect of reboxetine on appetite and weight gain in olanzapine-treated schizophrenia patients: a double-blind placebo-controlled study

Rationale Search for safe and effective strategies to diminish weight gain associated with second generation antipsychotics (SGAs) is imperative. In the present study, we sought to replicate our preliminary findings, which indicated that coadministration of the selective norepinephrine reuptake inhibitor reboxetine attenuates olanzapine-induced weight gain. Materials and method Fifty-nine patients hospitalized for first-episode DSM-IV schizophrenic disorder participated in this randomized double-blind study. Reboxetine (4 mg/day; 31 patients) or placebo (29 patients) was coadministered with olanzapine (10 mg/day) for 6 weeks. Analysis was by intention-to-treat. Results Nine patients in each group prematurely discontinued the trial. Olanzapine/reboxetine-treated patients showed a significantly lower increase in body weight (mean = 3.31 kg, SD = 2.73) than their olanzapine/placebo-treated counterparts (mean = 4.91 kg, SD = 2.45). Significantly fewer olanzapine/reboxetine-treated patients gained at least 7% of their initial weight, the cutoff for clinically significant weight gain (6 [19.4%] of 31 patients vs 13 [46.4%] of 28 patients). Seven (22.6%) olanzapine/reboxetine-treated patients compared to only one patient (3.6%) in the olanzapine/placebo group revealed no weight change or even modest weight loss. Appetite increase was significantly lower in the olanzapine/reboxetine than olanzapine/placebo group and was correlated with attenuation of weight gain. Reboxetine addition was safe and well tolerated. Conclusions The results confirm that coadministration of reboxetine promotes a clinically meaningful attenuation of olanzapine-induced weight gain in schizophrenia patients. If substantiated in long-term studies, along with behavioral management and diet counseling, reboxetine may have a clinical utility in controlling SGA-induced weight gain.     

Daytime sleepiness and EEG abnormalities in patients treated with second generation antipsychotic agents

BackgroundThe aim of this study was to verify whether or not an increased prevalence of excessive daytime sleepiness (EDS) or EEG abnormalities is observed in patients with schizophrenia spectrum disorders (SSD), and to compare the effects of second generation antipsychotics (SGA) on patients’ daytime sleepiness level and EEG recordings.MethodsEEG recordings and self-reports of EDS, assessed with Epworth (ESS) and Stanford (SSS) Sleepiness Scales, were compared between 244 patients with SSD and 82 patients with anxiety, personality or behavioral disorders (non-psychotic disorders, NPD). To examine the effects of various SGA, patients treated in monotherapy with aripiprazole, olanzapine, clozapine, risperidone and sertindole were compared.ResultsA higher prevalence of abnormal EEG recordings was observed in SSD patients. No significant differences in average daytime sleepiness were found between patients with SSD and NPD; however, patients with SSD had longer sleep duration. Aripiprazole treatment was associated with significantly smaller and less frequent EEG abnormalities than treatment with any other SGA, while treatment with clozapine and olanzapine was related to an increased prevalence of severe EEG abnormalities. Patients with SSD treated with SGA in monotherapy were less sleepy than unmedicated patients with NPD.ConclusionsAlthough antipsychotics may have profound effects on EEG patients with schizophrenia do not have higher daytime sleepiness than patients with anxiety/personality disorders. Patients with schizophrenia may compensate sedative effects of antipsychotic treatment with sleep duration prolongation and report even less sleepiness than non-psychotic patients.     

Long-acting injectable antipsychotics in the treatment of schizophrenia: their role in relapse prevention

Importance of the field: Antipsychotic medications are the cornerstone of treatment in schizophrenia, and a large body of data confirms the value of ongoing and continuous antipsychotic pharmacotherapy in controlling symptoms and preventing relapse. However, nonadherence with antipsychotic treatment is a significant issue, with estimates as high as 90%.

Areas covered in this review: This review focuses on long-acting injectable (LAI) antipsychotics and their role in the treatment of schizophrenia. The existing literature, with an emphasis on clinical evidence, is assessed. This includes both reviews and specific trials that examine LAIs and compare them with oral agents, with measures ranging from relapse and rehospitalization to adherence. Both advantages and limitations (e.g., challenges in terms of dose titration and time to steady state) are examined.

What the reader will gain: This overview serves as an update for clinicians wishing to understand LAIs better, including the newer second-generation antipsychotics (SGAs) with this formulation available, and their potential role in the long-term treatment of individuals with schizophrenia.

Take home message: Despite identified advantages, LAIs are not used as widely as might be expected. It would seem that clinicians are at least partly responsible for this, influenced by our own misperceptions (e.g., that LAIs are not acceptable to patients) and, perhaps, misinformation (e.g., increased side effect risk). As clinicians, we may well be shortchanging LAIs if we position them as a treatment of last resort for the multi-episode, nonadherent, ‘revolving door’ patient, especially given recent evidence underscoring their potential benefits in first-episode patients. The search for new and more effective antipsychotics will continue, but we are reminded that suboptimal outcomes may have as much to do with nonadherence as inadequate treatments. Evidence has established that LAI antipsychotics demonstrate distinct benefits in this regard, and we would be remiss if we did not exploit this already available strategy. As well as additional research, we need to rethink how we position these agents in our treatment algorithms if we are to maximize their potential.     

精神分裂症认知功能与抗精神病药物

精神分裂症患者常伴有认知功能损害.最近关于抗精神病药物对认知功能影响的研究很多.本文对可能导致认知功能损害的机制以及精神分裂症认知功能与不同抗精神病药物之间的关系作一简要综述.     

Moderators of placebo response to antipsychotic treatment in patients with schizophrenia: a meta-regression

Abstract Rationale. Variation in placebo response within and among clinical trials involving patients with schizophrenia can substantially affect conclusions about the efficacy of new antipsychotic medications. Therefore, it is of great importance to identify factors that moderate response to placebo in such trials. Objective. The objective of this meta-regression analysis was to estimate the effect of potential moderators of placebo response in randomized, short-term clinical trials involving patients with schizophrenia, schizoaffective disorder or schizophreniform disorder. Methods. Mean placebo response and potential moderators were extracted from 35 placebo-controlled, randomized trials of antipsychotic medications in patients with schizophrenia. Placebo response was defined as the absolute change in the Brief Psychiatric Rating Scale total score. Fixed-effects meta-regression was used to investigate between-trial variation in placebo response. Results. Trial duration accounted for a substantial proportion of the between-trial variation in response (27%), with greater improvement on placebo observed in shorter trials. Other variables showed insufficient variation across trials to permit any inferences regarding their relationships with placebo response. Conclusions. Placebo-controlled trials of short duration (<6–8 weeks) are vulnerable to substantial placebo response. Recruiting patients with more severe pathology to mitigate placebo response does not appear to offer benefits and may even be counterproductive. Meta-analyses based on individual patient data offer the potential for much more detailed and inferentially sound exploration of factors affecting placebo response and are highly recommended. Electronic Publication     

Effects of typical and atypical antipsychotics on prepulse inhibition in schizophrenia: a critical evaluation of current evidence and directions for future research

Prepulse inhibition (PPI) of the startle response refers to an attenuation in response to a strong stimulus (pulse) if this is preceded shortly by a weak non-startling stimulus (prepulse). PPI provides a simple operational measure of sensorimotor gating, serving to prevent the interruption of ongoing perceptual and early sensory analysis. In accord with postulated deficits in early stages of information processing, there is ample evidence that PPI is disrupted in individuals with schizophrenia. PPI in animals is thought to represent a well-validated model for evaluating potential new treatments for schizophrenia. Currently, available data on the differential effects of typical and atypical antipsychotics suggest that atypical antipsychotics, in particular clozapine and risperidone, may be more effective than typical antipsychotics in improving PPI deficits in schizophrenia. However, studies have so far used small samples and/or between-subjects designs, and not examined the effects of other concomitant medications that may also influence PPI. The directions are identified for further applications of this model using within-subjects longitudinal designs and reasonable sample sizes to establish superiority of particular atypical antipsychotics over typical antipsychotics in improving PPI in schizophrenic populations.     

One-year clinical and economic consequences of oral atypical antipsychotics in the treatment of schizophrenia

ABSTRACT

Objective: To assess the clinical and economic consequences of oral atypical antipsychotic treatment (aripiprazole, olanzapine, paliperidone ER, quetiapine, risperidone, and ziprasidone) in schizophrenia over one-year from a US healthcare system perspective.

Methods: The decision model captured rates of discontinuation, symptom response, frequency and duration of relapse, adverse events (extrapyramidal symptoms and weight gain), resource utilization, and unit costs. Published randomized, double-blind, placebo-controlled clinical trial data were used to obtain response rates for comparators. Published clinical trial data from long-term effectiveness trials reflective of typical clinical settings were used for time on therapy, rates of discontinuation, likelihood of switching, relapse rates, and adverse event rates. Drug costs were based on Wholesale Acquisition Cost weighted by Wolters Kluwer Retail and First Databank Pricing drug utilization data. PharMetrics Patient-Centric database was utilized for length of stay, frequency of relapse, and unit cost of healthcare resource data. A clinical expert panel provided resource-use information not available in published literature or healthcare databases. To test the robustness of the findings, sensitivity analyses were performed using plausible ranges of key model input parameters.

Results: The model estimated that, over 1 year, clinical outcomes of patients administered oral atypical antipsychotics would not vary considerably. This is partly due to differences ‘washing out’ because of frequent switching and discontinuation of medication. Economic outcomes did vary among pharmacotherapies: paliperidone ER was associated with cost savings in direct medical costs per patient per year compared to risperidone (cost savings using paliperidone ER vs. risperidone: $793), quetiapine ($1191), olanzapine ($1259), ziprasidone ($2159), and aripiprazole ($2204)). Limitations of this analysis include the absence of direct head-to-head long-term comparative data for antipsychotics. However, the results of the decision analysis held true when tested through a multitude of sensitivity analyses.

Conclusion: This modeling study showed that paliperidone ER had the most favorable clinical and economic outcomes compared to other oral atypical antipsychotics for patients with schizophrenia. The analysis supports the notion that frequent discontinuation of medication is a problem with all oral antipsychotic treatments for schizophrenia.