Kasper S, Müller-Spahn F
Department of General Psychiatry, University of Vienna, Vienna, Austria.
Expert Opin Pharmacother. 2000 May;1(4):783-801. doi: 10.1517/14656566.1.4.783.
Preclinical studies have shown that quetiapine (Seroquel, AstraZeneca) is an atypical antipsychotic with many similarities to clozapine. Both placebo-controlled and comparative studies in patients with schizophrenia have demonstrated that quetiapine has long-term efficacy in both positive and negative domains, as well as beneficial effects on affective and cognitive symptoms. Comparative clinical studies confirm that quetiapine is at least as effective as the standard antipsychotics, chlorpromazine and haloperidol and response rates with quetiapine are similar to those reported with other atypical antipychotics. Quetiapine has also demonstrated superior efficacy to haloperidol in partially responsive patients, who can be particularly difficult to treat. Quetiapine has a wide clinical dosing range (150-750 mg/day), although doses of 400 mg or above should be used in patients who do not fully respond to lower doses of the drug. Quetiapine is generally well tolerated with no requirement for routine ECG or blood monitoring and it has minimal effects on weight. Uniquely among other first-line atypical antipsychotics, quetiapine is associated with a placebo-level incidence of EPS and an indistinguishable effect from placebo on plasma prolactin at all doses. Thus, clinicians can confidently increase the dose of quetiapine, without increasing the risk of EPS or hyperprolactinaemia. A number of studies have also shown that quetiapine is well-tolerated and effective in patients who are particularly susceptible to EPS, including elderly and adolescent patients and those with pre-existing dopaminergic pathology, such as Alzheimer's disease and Parkinson's disease. The consistent efficacy in treating all schizophrenic domains and good tolerability, particularly placebo-level EPS, make quetiapine acceptable to patients, as demonstrated in a survey of patient satisfaction. Thus quetiapine is a suitable first-line therapy for the treatment of schizophrenia and psychosis.
临床前研究表明，喹硫平（思瑞康，阿斯利康公司）是一种非典型抗精神病药物，与氯氮平有许多相似之处。在精神分裂症患者中进行的安慰剂对照研究和比较研究均表明，喹硫平在阳性和阴性症状方面均具有长期疗效，对情感和认知症状也有有益作用。比较临床研究证实，喹硫平至少与标准抗精神病药物氯丙嗪和氟哌啶醇一样有效，且喹硫平的有效率与其他非典型抗精神病药物报告的有效率相似。在部分反应性患者中，喹硫平还显示出优于氟哌啶醇的疗效，而这些患者可能特别难以治疗。喹硫平具有较宽的临床给药范围（150 - 750毫克/天），不过对于对较低剂量药物未完全反应的患者，应使用400毫克或更高剂量。喹硫平一般耐受性良好，无需常规进行心电图或血液监测，对体重影响极小。在其他一线非典型抗精神病药物中，喹硫平的独特之处在于其EPS发生率与安慰剂相当，且在所有剂量下对血浆催乳素的影响与安慰剂无差异。因此，临床医生可以放心增加喹硫平的剂量，而不会增加EPS或高催乳素血症的风险。多项研究还表明，喹硫平在特别易患EPS的患者中耐受性良好且有效，这些患者包括老年和青少年患者以及那些已有多巴胺能病变的患者，如阿尔茨海默病和帕金森病患者。正如一项患者满意度调查所示，喹硫平在治疗精神分裂症的各个方面疗效一致且耐受性良好，尤其是安慰剂水平的EPS，这使得患者能够接受喹硫平。因此，喹硫平是治疗精神分裂症和精神病的合适一线疗法。
