Dietrich D E, Kropp S, Emrich H M
Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School, Germany. dietrich@
Pharmacopsychiatry. 2001 Nov;34(6):242-50. doi: 10.1055/s-2001-18036.
Anticonvulsants have been successfully used in pharmacopsychiatry after their therapeutic value in affective and schizoaffective disorders had been documented in several clinical trials. As the authorities in several countries registered newer anticonvulsants with fewer side effects, their therapeutic value in psychiatric disorders was studied. Clinical studies from the early 80's onward have demonstrated the efficacy of oxcarbazepine (OCBZ), a keto derivative of carbamazepine, in treating mania in affective and schizoaffective disorders. In addition, OCBZ has a distinct pharmacokinetic profile concerning drug-drug interactions compared to carbamazepine and other anticonvulsants. Therefore, the value of OCBZ in the treatment of affective and schizoaffective disorders needs to be evaluated. We reviewed the literature with regard to pharmacokinetic and pharmacodynamic characteristics of OCBZ, drug-drug interactions relevant in pharmacopsychiatry, and the clinical effects of OCBZ in the treatment of patients with affective and schizoaffective disorders. According to the literature, OCBZ is regarded as effective in acute mania and appears to reduce the dosage of neuroleptics required for the treatment of affective and schizoaffective disorders. In addition, it has a preferable pharmacokinetic profile with less severe side effects compared to carbamazepine and neuroleptics. Furthermore, since OCBZ does not interact substantially with the cytochrome P450 enzyme system, co-administration with neuroleptics or antidepressants appears to be well tolerated in affective disorders. However, despite promising effects of OCBZ, few clinical studies have been published in the last 15 years. We conclude that further studies should validate the efficacy of OCBZ in treating mania and evaluate possible pharmacopsychiatric indications as well as limitations for this psychotropic compound.
在多项临床试验证明抗惊厥药在情感障碍和分裂情感性障碍中有治疗价值后，它们已成功应用于药物精神病学领域。随着一些国家的当局批准了副作用较少的新型抗惊厥药，人们对它们在精神疾病中的治疗价值进行了研究。从80年代初开始的临床研究表明，卡马西平的酮衍生物奥卡西平（OCBZ）在治疗情感障碍和分裂情感性障碍的躁狂发作方面具有疗效。此外，与卡马西平和其他抗惊厥药相比，OCBZ在药物相互作用方面具有独特的药代动力学特征。因此，需要评估OCBZ在治疗情感障碍和分裂情感性障碍中的价值。我们回顾了有关OCBZ的药代动力学和药效学特征、药物精神病学中相关的药物相互作用以及OCBZ在治疗情感障碍和分裂情感性障碍患者中的临床效果的文献。根据文献，OCBZ被认为对急性躁狂有效，并且似乎可以减少治疗情感障碍和分裂情感性障碍所需的抗精神病药物剂量。此外，与卡马西平和抗精神病药物相比，它具有较好的药代动力学特征，副作用较轻。此外，由于OCBZ与细胞色素P450酶系统没有实质性相互作用，在情感障碍中与抗精神病药物或抗抑郁药物联合使用似乎耐受性良好。然而，尽管OCBZ有令人期待的效果，但在过去15年中发表的临床研究很少。我们得出结论，进一步的研究应验证OCBZ治疗躁狂的疗效，并评估这种精神药物可能的药物精神病学适应症以及局限性。
