Yatham Lakshmi N
University of British Columbia, Vancouver, Canada.
J Clin Psychopharmacol. 2003 Jun;23(3 Suppl 1):S9-14. doi: 10.1097/01.jcp.0000084036.22282.ea.
Lithium and valproate are well recognized as mood-stabilizing medications. However, a significant number of patients with bipolar disorder do not respond to or cannot tolerate the side effects of these drugs. As a result, a search for safer and more effective mood stabilizers for the treatment of bipolar disorder is ongoing. Antipsychotic medications have long been used as adjunctive therapy in combination with mood-stabilizing medications. Although conventional neuroleptics (also known as typical antipsychotics) such as haloperidol or chlorpromazine are effective antimanic agents, they do not appear to have any efficacy in treating comorbid depressive symptoms. Furthermore, typical antipsychotics are associated with a number of well-known side effects, such as extrapyramidal symptoms and tardive dyskinesia. Mood-stabilizing effects have recently been reported for a number of newer "atypical" antipsychotics that have a broader spectrum of efficacy and better safety profiles than the typical antipsychotics. The results of several clinical trials suggest that atypical antipsychotics, including risperidone, olanzapine, ziprasidone, and quetiapine, are effective for the treatment of acute mania, and open-label studies suggest that atypical antipsychotics may have long-term mood-stabilizing effects.
锂盐和丙戊酸盐是公认的心境稳定剂。然而，相当数量的双相情感障碍患者对这些药物无反应或无法耐受其副作用。因此，人们一直在寻找更安全、更有效的心境稳定剂来治疗双相情感障碍。抗精神病药物长期以来一直作为辅助治疗药物与心境稳定剂联合使用。尽管传统的抗精神病药物（也称为典型抗精神病药物）如氟哌啶醇或氯丙嗪是有效的抗躁狂药物，但它们似乎对治疗共病的抑郁症状没有任何疗效。此外，典型抗精神病药物会产生许多众所周知的副作用，如锥体外系症状和迟发性运动障碍。最近有报道称，一些新型“非典型”抗精神病药物具有心境稳定作用，其疗效谱比典型抗精神病药物更广，安全性更好。几项临床试验的结果表明，包括利培酮、奥氮平、齐拉西酮和喹硫平在内的非典型抗精神病药物对急性躁狂的治疗有效，开放标签研究表明非典型抗精神病药物可能具有长期的心境稳定作用。
