Neil Wendy, Curran Stephen, Wattis John
Specialist Registrar in Old Age Psychiatry, Bradford Community Health NHS Trust, Lynfield Mount Hospital, Bradford, UK.
Age Ageing. 2003 Sep;32(5):475-83. doi: 10.1093/ageing/afg061.
Antipsychotic medications have made a significant contribution to the care of the mentally ill people over the past 50 years, with good evidence that both typical and atypical agents are effective in the treatment of schizophrenia and related conditions. In addition they are widely used to good effect in other disorders including psychotic depression, dementia and delirium. Both typical and atypical agents may cause severe side-effects and, in the elderly in particular, there is an increased propensity for drug interactions. If used with care, antipsychotics are usually well tolerated, especially the atypical drugs. Although antipsychotics are effective at reducing psychotic symptoms their limitations should be recognised. They do not 'cure' the underlying illness, and the management of psychotic and behavioural symptoms must take into consideration treatment of physical illness as well as psychosocial interventions. In addition, the antipsychotic effect may take one to two weeks to be evident so doses should not be increased too rapidly. Often small doses are effective in the elderly if they are given sufficient time to work. As our understanding of the mechanisms of psychosis improves it is hoped that new drugs will be developed with novel mechanisms of action with improved efficacy and reduced side-effects. There are several drugs in development, some sharing similarities to currently available agents whilst others have novel mechanisms of actions involving glutamate and nicotinic receptors. Pharmacogenetics is also likely to be increasingly important over the next few years. As the genetic basis of many psychiatric disorders becomes more clearly established it is likely that drugs specifically designed for particular sub-groups of receptors will be developed. Finally, although the pharmacological treatment of psychotic disorders in younger people has been given considerable attention, there is a paucity of good quality research on antipsychotic drug use in older people. There is a need to redress this balance to ensure that the prescribing of antipsychotics in older people is evidence based.
在过去50年里，抗精神病药物对精神疾病患者的护理做出了重大贡献，有充分证据表明，传统和非典型抗精神病药物在治疗精神分裂症及相关病症方面均有效。此外，它们还广泛用于其他疾病，包括伴有精神病性症状的抑郁症、痴呆和谵妄，且疗效良好。传统和非典型抗精神病药物都可能引起严重的副作用，尤其是在老年人中，药物相互作用的可能性增加。如果谨慎使用，抗精神病药物通常耐受性良好，尤其是非典型药物。尽管抗精神病药物在减轻精神病性症状方面有效，但也应认识到它们的局限性。它们不能“治愈”潜在疾病，精神病性和行为症状的管理必须考虑到躯体疾病的治疗以及社会心理干预。此外，抗精神病作用可能需要一到两周才能显现，因此剂量不应增加过快。如果给老年人足够的时间发挥作用，小剂量通常就有效。随着我们对精神病机制的理解不断提高，希望能开发出具有新作用机制、疗效更好且副作用更小的新药。目前有几种药物正在研发中，有些与现有药物有相似之处，而另一些则具有涉及谷氨酸和烟碱受体的新作用机制。药物遗传学在未来几年可能也会变得越来越重要。随着许多精神疾病的遗传基础越来越明确，可能会开发出专门针对特定受体亚组的药物。最后，尽管年轻人精神病性障碍的药物治疗受到了相当多的关注，但关于老年人使用抗精神病药物的高质量研究却很少。需要纠正这种平衡，以确保老年人抗精神病药物的处方是基于证据的。
