Tandon Rajiv
University of Michigan Medical Center, Ann Arbor, MI 48109-0120, USA.
Psychiatr Q. 2002 Winter;73(4):297-311. doi: 10.1023/a:1020464017021.
Previously, clinicians worked with antipsychotic drugs that almost invariably caused extrapyramidal side effects (EPS) at the dose at which they were clinically effective. By definition, all newer generation atypical antipsychotic agents are significantly better than conventional agents with regard to EPS; i.e., they are clinically effective at doses at which they do not cause EPS. This EPS advantage of atypical antipsychotics translates into several important clinical benefits, including better negative symptom efficacy, lesser dysphoria, less impaired cognition, and a lower risk of tardive dyskinesia; in fact, this "EPS advantage" is the principal basis of the many clinical advantages provided by the class of atypical antipsychotics. While all atypical agents share this "EPS advantage," there are important differences between these agents with regard to the ease and consistency with which this EPS advantage can be realized. Pharmacologically, different atypical antipsychotics differ; these differences translate into differences in their side effect profiles. Five atypical antipsychotics are currently available: clozapine, risperidone, olanzapine, quetiapine, and ziprasidone. Meaningful differences between these agents with regard to weight gain, sedation, anticholinergic side effects, cardiovascular issues, endocrine side effects, hepatic and sexual issues, will be considered and their clinical implications discussed.
以前，临床医生使用的抗精神病药物在临床有效剂量下几乎总会引起锥体外系副作用（EPS）。根据定义，所有新一代非典型抗精神病药物在EPS方面明显优于传统药物；也就是说，它们在不会引起EPS的剂量下具有临床疗效。非典型抗精神病药物的这种EPS优势转化为几个重要的临床益处，包括更好的阴性症状疗效、较少的烦躁不安、较少的认知损害以及迟发性运动障碍的较低风险；事实上，这种“EPS优势”是该类非典型抗精神病药物提供众多临床优势的主要基础。虽然所有非典型药物都具有这种“EPS优势”，但在实现这种EPS优势的难易程度和一致性方面，这些药物之间存在重要差异。在药理学上，不同的非典型抗精神病药物有所不同；这些差异转化为它们副作用谱的差异。目前有五种非典型抗精神病药物：氯氮平、利培酮、奥氮平、喹硫平和齐拉西酮。将考虑这些药物在体重增加、镇静作用、抗胆碱能副作用、心血管问题、内分泌副作用、肝脏和性方面问题上的显著差异，并讨论其临床意义。
