Alevizos Basil, Lykouras Lefteris, Zervas Iannis M, Christodoulou George N
Department of Psychiatry, University of Athens, Eginition Hospital, Greece.
J Clin Psychopharmacol. 2002 Oct;22(5):461-7. doi: 10.1097/00004714-200210000-00004.
Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT and D receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.(2) (2)
利培酮是一种新型非典型药物，对5-羟色胺（5-HT）和多巴胺（D）受体具有双重拮抗作用。开放性报告和一项对照研究表明，对于经血清素再摄取抑制剂治疗无效的强迫症患者，加用利培酮有效。然而，利培酮也与强迫症状的产生或加重有关。我们报告了6例患者（精神分裂症5例，精神病性抑郁症1例），利培酮对其精神病性症状治疗有效，但产生了强迫症状（4例）或使既往强迫症状加重（2例）。除1例患者外，所有患者在利培酮治疗开始且剂量高于3mg/天后不久便出现了强迫症状。利培酮及其他非典型抗精神病药物诱发或加重强迫症状的机制和危险因素尚不清楚。利培酮诱发的强迫症状似乎与剂量有关，可能由5-羟色胺能-多巴胺能失衡所致。对接受利培酮治疗的患者，尤其是那些易出现强迫症状的患者进行密切监测可能会有帮助。逐渐增加剂量并采用低维持剂量可能有益。
