Ghaemi S N
Consolidated Department of Psychiatry, Harvard Medical School, Cambridge Hospital, Mass, USA.
J Clin Psychiatry. 2000;61 Suppl 14:33-42.
Atypical neuroleptic agents are an excellent, safer, and more effective alternative to the widespread practice of maintenance adjunctive treatment with traditional neuroleptic agents in patients with bipolar disorder. Currently, a number of prospective studies are available with clozapine, risperidone, olanzapine, and quetiapine in the treatment of bipolar disorder. Most are short-term studies, although longer-term data are becoming available. Four double-blind studies of acute mania have been conducted with risperidone and olanzapine, leading to recent Food and Drug Administration approval for olanzapine in the indication of acute mania. Given the limited longer-term data, and the evidence for mostly adjunctive benefits with these agents, it seems unlikely that these agents will prove to be primary mood stabilizers in their own right. Nonetheless, they serve an important role as adjunctive treatments along with standard mood stabilizers in the rational polypharmacy of bipolar disorder. To date, differences in efficacy have not been established. However, differences in the side effect of weight gain may be even more relevant in bipolar disorder than in schizophrenia due to the need to use standard mood stabilizers that often potentiate such weight gain.
非典型抗精神病药物是双相情感障碍患者中，替代广泛使用的传统抗精神病药物维持辅助治疗的一种优秀、更安全且更有效的选择。目前，有多项关于氯氮平、利培酮、奥氮平和喹硫平治疗双相情感障碍的前瞻性研究。大多数是短期研究，不过长期数据也越来越多。已经进行了四项关于利培酮和奥氮平治疗急性躁狂的双盲研究，这使得奥氮平最近获得了美国食品药品监督管理局（FDA）在急性躁狂适应症方面的批准。鉴于长期数据有限，且这些药物大多显示出辅助益处的证据，这些药物似乎不太可能凭自身成为主要的心境稳定剂。尽管如此，在双相情感障碍的合理联合用药中，它们作为标准心境稳定剂的辅助治疗发挥着重要作用。迄今为止，尚未确定它们在疗效上的差异。然而，由于需要使用常常会增强体重增加的标准心境稳定剂，体重增加副作用方面的差异在双相情感障碍中可能比在精神分裂症中更为重要。
