Kim Kwang-Soo, Pae Chi-Un, Chae Jeong-Ho, Bahk Won-Myong, Jun Tae-Youn, Kim Dai-Jin, Dickson Ruth A
Department of Psychiatry, St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
J Clin Psychiatry. 2002 May;63(5):408-13. doi: 10.4088/jcp.v63n0506.
This study was conducted to prospectively examine the effect of switching from risperidone to olanzapine on female schizophrenia patients who experienced menstrual disturbances, galactorrhea, and/or sexual dysfunction.
Twenty female patients with DSM-IV schizophrenia who were taking risperidone and were suffering from menstrual disturbances, galactorrhea, and/or sexual dysfunction were enrolled. Patients were switched from risperidone to olanzapine over a 2-week period, then treated with olanzapine for 8 additional weeks. The serum prolactin concentrations were examined every 2 weeks. The Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Scale for Extrapyramidal Symptoms (SAS), and questions from the Dickson-Glazer Sexual Functioning Scale were administered to evaluate efficacy, extrapyramidal side effects, and sexual and reproductive functioning at baseline and the endpoint of 10 weeks.
Serum prolactin levels decreased significantly (p < .01) following the switch from risperidone to olanzapine. Scores of PANSS, AIMS, and SAS at the endpoint were also significantly decreased (p < .01) compared to those of baseline. Patients experienced improvements in menstrual functioning and perceptions of sexual side effects.
Olanzapine reversed hyperprolactinemia in risperidone-treated female schizophrenic patients. This was associated with a decrease in amenorrhea, improved cycle regularity, and a decrease in sexual side effects that the women attributed to antipsychotic medication. This study suggests that switching to olanzapine is a safe and effective alternative method for patients with antipsychotic-induced hyperprolactinemia associated sexual and/or reproductive dysfunction. Long-term follow-up studies are warranted, with particular attention to the course of sexual and reproductive dysfunction.
本研究旨在前瞻性地考察从利培酮换用奥氮平对患有月经紊乱、溢乳和/或性功能障碍的女性精神分裂症患者的影响。
招募了20名服用利培酮且患有月经紊乱、溢乳和/或性功能障碍的DSM-IV精神分裂症女性患者。患者在2周内从利培酮换用奥氮平，然后再用奥氮平治疗8周。每2周检测血清催乳素浓度。在基线和10周终点时，使用阳性和阴性症状量表（PANSS）、异常不自主运动量表（AIMS）、锥体外系症状辛普森-安格斯量表（SAS）以及迪克森-格雷泽性功能量表中的问题来评估疗效、锥体外系副作用以及性和生殖功能。
从利培酮换用奥氮平后，血清催乳素水平显著降低（p <.01）。与基线相比，终点时PANSS、AIMS和SAS的评分也显著降低（p <.01）。患者的月经功能和对性副作用的感受有所改善。
奥氮平可逆转利培酮治疗的女性精神分裂症患者的高催乳素血症。这与闭经减少、月经周期规律性改善以及女性归因于抗精神病药物的性副作用减少有关。本研究表明，对于患有抗精神病药物引起的高催乳素血症相关性和/或生殖功能障碍的患者，换用奥氮平是一种安全有效的替代方法。有必要进行长期随访研究，尤其要关注性和生殖功能障碍的病程。
