Lerner Vladimir, Libov Igor, Kotler Moshe, Strous Rael D
Be'er-Sheva Mental Health Center, Faculty of Health Sciences Ben-Gurion, University of the Negev, P.O. Box 4600, Be'er-Sheva 84170, Israel.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Jan;28(1):89-98. doi: 10.1016/j.pnpbp.2003.09.024.
This article reviews the published clinical data on treatment-resistant schizophrenic and schizoaffective patients managed with combinations of "atypical" antipsychotic medication.
A computerized MEDLINE literature search covering an 18-year period (1985-2003) was conducted. All pertinent papers on the subject of the use of combination "atypical" antipsychotic medication in the management of treatment-resistant schizophrenia and schizoaffective disorder were obtained with subsequent analysis and discussion of the retrieved data.
The search identified 29 case reports and case series reports (172 patients) and one double-blind placebo-controlled trial (28 patients) describing the use of combination "atypical" antipsychotic medication (clozapine-risperidone; clozapine-sulpiride; clozapine-olanzapine; clozapine-quetiapine; olanzapine-sulpiride; olanzapine-quetiapine; risperidone-olanzapine; risperidone-quetiapine) in the treatment of resistant schizophrenic and schizoaffective patients. An overview of results suggests that the combinations were beneficial in the described patients with reduction of positive symptoms and occasionally negative symptoms. Significant adverse effects, while rare, were reported in a few cases and did not appear to different in nature from those managed on monotherapeutic regimens.
Combinations of "atypical" antipsychotic medications are well tolerated and may be effective in the management of treatment refractory schizophrenia and schizoaffective disorder. However, further double-blind placebo-controlled trials are required in order to test and confirm these observations.
本文回顾了已发表的关于使用“非典型”抗精神病药物联合治疗难治性精神分裂症和分裂情感性障碍患者的临床数据。
进行了一项涵盖18年（1985 - 2003年）的计算机化MEDLINE文献检索。获取了所有关于使用联合“非典型”抗精神病药物治疗难治性精神分裂症和分裂情感性障碍的相关论文，并对检索到的数据进行了后续分析和讨论。
检索确定了29篇病例报告和病例系列报告（172例患者）以及1项双盲安慰剂对照试验（28例患者），描述了联合使用“非典型”抗精神病药物（氯氮平 - 利培酮；氯氮平 - 舒必利；氯氮平 - 奥氮平；氯氮平 - 喹硫平；奥氮平 - 舒必利；奥氮平 - 喹硫平；利培酮 - 奥氮平；利培酮 - 喹硫平）治疗难治性精神分裂症和分裂情感性障碍患者的情况。结果概述表明，这些联合用药对所描述的患者有益，可减轻阳性症状，偶尔也能减轻阴性症状。虽有少数病例报告了显著的不良反应，但较为罕见，且其性质似乎与单一疗法治疗时所出现的不良反应并无不同。
“非典型”抗精神病药物联合使用耐受性良好，可能对难治性精神分裂症和分裂情感性障碍的治疗有效。然而，需要进一步进行双盲安慰剂对照试验以检验和证实这些观察结果。
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