Khullar A, Chue P, Tibbo P
University of Alberta, Edmonton, Alta.
J Psychiatry Neurosci. 2001 Jan;26(1):55-9.
The atypical antipsychotics have advanced the treatment of schizophrenia and have proved to be effective agents in treating other disorders with or without psychotic features. We review the literature concerning an increasingly reported and interesting adverse effect, atypical antipsychotic-induced obsessive-compulsive symptoms (OCS). The first known report of quetiapine exacerbating OCS in a 43-year-old man with obsessive-compulsive disorder (OCD), trichotillomania, delusional disorder and bipolar II disorder is presented. Mechanisms, including 5-HT2A and 5-HT2C antagonism, serotonergic regulation of dopamine systems and putative dopaminergic subtypes of OCS and OCD, are discussed. Given the paradoxical efficacy of the atypical antipsychotics in pure OCD, the neurobiology and comorbidity of OCD and schizophrenia, as well as the increasing use of atypical antipsychotics, a cautious and rational pharmacotherapeutic treatment approach is recommended.
非典型抗精神病药物推动了精神分裂症的治疗，并已被证明是治疗伴有或不伴有精神病性特征的其他疾病的有效药物。我们回顾了有关一种越来越多地被报道且有趣的不良反应——非典型抗精神病药物诱发的强迫症状（OCS）的文献。本文介绍了首例已知的关于喹硫平加重一名患有强迫症（OCD）、拔毛癖、妄想障碍和双相II型障碍的43岁男性的OCS的报告。文中讨论了其机制，包括5-HT2A和5-HT2C拮抗作用、多巴胺系统的5-羟色胺能调节以及OCS和OCD假定的多巴胺能亚型。鉴于非典型抗精神病药物在单纯OCD中的矛盾疗效、OCD和精神分裂症的神经生物学及共病情况，以及非典型抗精神病药物的使用日益增加，建议采用谨慎且合理的药物治疗方法。
