Zoccali Rocco, Muscatello Maria Rosaria, Cedro Clemente, Neri Pietro, La Torre Diletta, Spina Edoardo, Di Rosa Antonio Enrico, Meduri Mario
Section of Psychiatry, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Messina, Italy.
Int Clin Psychopharmacol. 2004 Mar;19(2):71-6. doi: 10.1097/00004850-200403000-00003.
The development of therapeutic strategies to effectively treat negative symptoms remains one of the primary goals in the treatment of schizophrenia. Mirtazapine is the first of a new class of dual action compounds, the noradrenergic and specific serotonergic antidepressants (NaSSa), whose activity is related to the enhancement of noradrenergic and serotonergic transmission by a presynaptic alpha2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism, respectively. This study was a 8-week double-blind, randomized, placebo-controlled trial of 30 mg adjunctive mirtazapine to clozapine therapy in 24 patients with DSM-IV schizophrenia. The main finding at the end of the trial was a significant reduction on the Scale for the Assessment of Negative Symptoms (SANS) total scores in the mirtazapine group compared to placebo (P<0.01) with a significant improvement on the SANS subscales avolition/apathy and anhedonia/asociality. The Brief Psychiatric Rating Scale total score at week 8 showed superiority of mirtazapine over placebo. These findings suggest a potential role for mirtazapine as an augmentation strategy in the treatment of negative symptoms of schizophrenia.
开发有效治疗阴性症状的治疗策略仍然是精神分裂症治疗的主要目标之一。米氮平是新型双效化合物中的首个药物，即去甲肾上腺素能和特异性5-羟色胺能抗抑郁药（NaSSa），其活性分别与通过突触前α2拮抗作用增强去甲肾上腺素能传递以及通过突触后5-HT2和5-HT3拮抗作用增强5-羟色胺能传递有关。本研究是一项为期8周的双盲、随机、安慰剂对照试验，对24例符合《精神疾病诊断与统计手册》第四版（DSM-IV）的精神分裂症患者在氯氮平治疗基础上加用30mg米氮平。试验结束时的主要发现是，与安慰剂组相比，米氮平组的阴性症状评定量表（SANS）总分显著降低（P<0.01），且在SANS的意志缺乏/淡漠及快感缺失/社交障碍分量表上有显著改善。第8周时的简明精神病评定量表总分显示米氮平优于安慰剂。这些发现表明米氮平作为增强策略在治疗精神分裂症阴性症状方面具有潜在作用。
