Stahl S M
Department of Psychiatry, University of California San Diego, and the Clinical Neuroscience Research Center, 92122, USA.
J Clin Psychiatry. 1999;60 Suppl 10:31-41.
Three atypical antipsychotics are currently considered to be first-line therapies for schizophrenia, namely risperidone, olanzapine, and quetiapine. Deciding which one of these agents to choose for any given patient can be a daunting task because head-to-head comparisons of these 3 agents are just beginning, and most published trials are comparisons with typical antipsychotics, not with another atypical antipsychotic. Furthermore, results from clinical trials often do not match findings from clinical practice. Thus, guidelines for selection and use of the atypical antipsychotics are evolving from controlled studies as well as from clinical judgment based on the practical use of these agents once they have entered clinical practice. The atypical properties of first-line atypical antipsychotics as well as clozapine are reviewed here, with clinical pearls and dosing tips for each based upon a consensus of information from both clinical trials and clinical practice. The conventional antipsychotic loxapine is also reviewed and proposed as a potentially valuable agent to augment atypical antipsychotics when patients do not experience an acceptable treatment response from monotherapy with an atypical antipsychotic. By integrating information from clinical trials and clinical practice, the prescriber can be in a better position to choose which atypical antipsychotic to select for any given patient.
目前，三种非典型抗精神病药物被视为精神分裂症的一线治疗药物，即利培酮、奥氮平和喹硫平。为任何特定患者选择其中一种药物可能是一项艰巨的任务，因为这三种药物的直接比较才刚刚开始，而且大多数已发表的试验都是与典型抗精神病药物进行比较，而非与另一种非典型抗精神病药物比较。此外，临床试验结果往往与临床实践结果不符。因此，非典型抗精神病药物的选择和使用指南正从对照研究以及基于这些药物进入临床实践后的实际使用情况的临床判断中不断演变。本文综述了一线非典型抗精神病药物以及氯氮平的非典型特性，并根据临床试验和临床实践的信息共识，为每种药物提供了临床要点和给药提示。还对传统抗精神病药物洛沙平进行了综述，并提出当患者使用非典型抗精神病药物单药治疗未获得可接受的治疗反应时，洛沙平作为增强非典型抗精神病药物疗效的潜在有价值药物。通过整合临床试验和临床实践的信息，开处方者能够更好地为任何特定患者选择合适的非典型抗精神病药物。
