Ross Randal G, Novins Doug, Farley Gordon K, Adler Lawrence E
Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
J Child Adolesc Psychopharmacol. 2003 Fall;13(3):301-9. doi: 10.1089/104454603322572633.
To determine the response of children with childhood-onset schizophrenia to a 1-year prospective, open-label trial of olanzapine.
Twenty children (age range 6-15 years) with childhood-onset Diagnostic and Statistical Manual of Mental Disorders (fourth edition) schizophrenia participated. The treating clinician was free to vary or discontinue dosing and use additional medications. Symptoms were assessed by the Brief Psychiatric Rating Scale-Child version (BPRS-C), Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms. Extrapyramidal symptoms, akathisia, temperature, and weight were monitored.
BPRS-C subscales of thought disturbance and psychomotor excitation, and the Scale for the Assessment of Positive Symptoms demonstrated significant decreases by 6 weeks of treatment; BPRS-C anxiety and the Scale for the Assessment of Negative Symptoms (SANS) showed significant improvement after 1 year of treatment. Seventy-four percent of subjects were considered treatment responders, with a greater than 20% reduction in total BPRS-C score and overall impairment of mild or better. Weight gain (body mass index) was above that expected for normal development in every child. No child developed neuroleptic-related dyskinesias. Seventy-four percent (n = 14) of patients completed this 1-year, open-label trial. Of the 5 subjects who discontinued, weight gain was noted as the reason for 4 subjects.
Olanzapine appears useful in the treatment of childhood-onset schizophrenia, although there may be a delayed onset of benefit for anxiety and negative symptoms. Weight gain is problematic, but the emergence of dyskinesias may be rare. Additional controlled trials are indicated.
通过一项为期1年的奥氮平前瞻性开放标签试验，确定儿童期起病的精神分裂症患儿的反应。
20名符合《精神障碍诊断与统计手册》（第四版）儿童期起病精神分裂症诊断标准的儿童（年龄范围6 - 15岁）参与试验。治疗医生可自由调整或停止给药，并使用其他药物。通过儿童简明精神病评定量表（BPRS - C）、阳性症状评定量表和阴性症状评定量表评估症状。监测锥体外系症状、静坐不能、体温和体重。
治疗6周后，BPRS - C的思维紊乱和精神运动性兴奋分量表以及阳性症状评定量表显示显著下降；治疗1年后，BPRS - C焦虑分量表和阴性症状评定量表（SANS）显示显著改善。74%的受试者被认为是治疗反应者，BPRS - C总分降低超过20%，总体损害为轻度或更好。每个儿童的体重增加（体重指数）均高于正常发育预期。没有儿童出现与抗精神病药物相关的运动障碍。74%（n = 14）的患者完成了这项为期1年的开放标签试验。在5名停药的受试者中，4名受试者的停药原因是体重增加。
奥氮平似乎对儿童期起病的精神分裂症治疗有效，尽管对焦虑和阴性症状的获益可能出现延迟。体重增加是个问题，但运动障碍的出现可能很少见。需要进行更多对照试验。
