Ramasubbu R, Ravindran A, Lapierre Y
Department of Psychiatry, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada.
Pharmacopsychiatry. 2000 Nov;33(6):236-8. doi: 10.1055/s-2000-8360.
Previous reports suggest that some atypical antipsychotics may have obsessogenic as well as antiobsessional effects. Given their higher affinity for serotonin 5HT2 receptors than dopamine D2 receptors, it has been speculated that atypical antipsychotics may induce obsessive-compulsive (OC) symptoms, even at low doses, due to high 5HT2 antagonism, whereas improvement in OC symptoms is thought to occur only at high doses due to high D2 antagonism.
In this open case series, the dose-response relationship of atypical antipsychotic augmentation in the treatment of obsessive compulsive disorder (OCD), and the dose-severity relationship in atypical anti psychotic-induced OC symptoms were examined. Three patients were identified who had either refractory OCD or OC symptoms following administration of atypical antipsychotics such as olanzapine and risperidone.
Case 1: A linear dose-response relationship between increasing doses of olanzapine and improvement in OC symptoms was observed in an OCD patient resistant to 5-HT reuptake inhibitors. 2: OC symptoms induced by low doses of risperidone (1 mg) were reversed by increasing the doses of risperidone (3 mg) in a bipolar disorder patient suggesting an inverse dose-severity relationship. 3: No inverse dose-severity relationship was noted between olanzapine induced OC symptoms and its dosage in an asymptomatic OCD patient. Tretment-emergence OC symptoms responded to increasing the doses of maintanance clomipramine treatment.
Controlled studies are needed to investigate the dose-response or dose-severity relationships between OCD and atypical antipsychotics.
先前的报告表明，一些非典型抗精神病药物可能具有致强迫作用以及抗强迫作用。鉴于它们对5-羟色胺5HT2受体的亲和力高于多巴胺D2受体，有人推测，非典型抗精神病药物可能由于高5HT2拮抗作用即使在低剂量时也会诱发强迫性神经症（OC）症状，而OC症状的改善被认为仅在高剂量时由于高D2拮抗作用才会出现。
在这个开放性病例系列中，研究了非典型抗精神病药物增效治疗强迫症（OCD）时的剂量-反应关系，以及非典型抗精神病药物诱发OC症状时的剂量-严重程度关系。确定了3例患者，他们要么患有难治性OCD，要么在服用奥氮平、利培酮等非典型抗精神病药物后出现OC症状。
病例1：在一名对5-羟色胺再摄取抑制剂耐药的OCD患者中，观察到奥氮平剂量增加与OC症状改善之间存在线性剂量-反应关系。病例2：在一名双相情感障碍患者中，低剂量利培酮（1毫克）诱发的OC症状通过增加利培酮剂量（3毫克）得到逆转，提示存在反向剂量-严重程度关系。病例3：在一名无症状的OCD患者中，未观察到奥氮平诱发的OC症状与其剂量之间存在反向剂量-严重程度关系。治疗中出现的OC症状对增加维持性氯米帕明治疗剂量有反应。
需要进行对照研究来调查OCD与非典型抗精神病药物之间的剂量-反应或剂量-严重程度关系。
