Lang Donna J, Kopala Lili C, Vandorpe Robert A, Rui Qing, Smith Geoffrey N, Goghari Vina M, Lapointe Jocelyne S, Honer William G
VGH Research Pavilion, Centre for Complex Disorders, West 10th Ave., Room 211-828, Vancouver, British Columbia, Canada V5Z 1L8.
Am J Psychiatry. 2004 Oct;161(10):1829-36. doi: 10.1176/ajp.161.10.1829.
A follow-up study of patients with schizophrenia was conducted to examine change in striatal volumes and extrapyramidal symptoms after a change in medication.
Thirty-seven patients with schizophrenia and 23 healthy volunteers were examined. Patients at baseline receiving typical antipsychotics (N=10) or risperidone but exhibiting limited response (N=13) were switched to treatment with olanzapine. Patients receiving risperidone and exhibiting a good response (N=14) continued treatment with risperidone. Caudate, putamen, and pallidal volumes were assessed with magnetic resonance imaging. The Extrapyramidal Symptoms Rating Scale was used to assess clinical signs and symptoms.
At baseline, basal ganglia volumes in patients treated with typical antipsychotics were greater than in healthy subjects (putamen: 7.0% larger; globus pallidus: 20.7% larger). After the switch to olanzapine, putamen and globus pallidus volumes decreased (9.8% and 10.7%, respectively) and did not differ from those of healthy subjects at the follow-up evaluation. Akathisia was also reduced. In the patients receiving risperidone at baseline, basal ganglia volumes did not differ between those exhibiting good and poor response, and no significant volume changes were observed in subjects with poor risperidone response after the switch to olanzapine treatment.
Olanzapine reversed putamen and globus pallidus enlargement induced by typical antipsychotics but did not alter volumes in patients previously treated with risperidone. Changes in striatal volumes related to typical and atypical antipsychotics may represent an interactive effect between individual medications and unique patient characteristics.
对精神分裂症患者进行一项随访研究，以检查药物改变后纹状体体积和锥体外系症状的变化。
对37名精神分裂症患者和23名健康志愿者进行了检查。基线时接受典型抗精神病药物治疗（N = 10）或利培酮但反应有限（N = 13）的患者改用奥氮平治疗。接受利培酮且反应良好（N = 14）的患者继续使用利培酮治疗。用磁共振成像评估尾状核、壳核和苍白球的体积。使用锥体外系症状评定量表评估临床体征和症状。
在基线时，接受典型抗精神病药物治疗的患者基底节体积大于健康受试者（壳核：大7.0%；苍白球：大20.7%）。改用奥氮平后，壳核和苍白球体积减小（分别为9.8%和10.7%），在随访评估时与健康受试者无差异。静坐不能也有所减轻。在基线时接受利培酮治疗的患者中，反应良好和反应不佳者之间基底节体积无差异，改用奥氮平治疗后，利培酮反应不佳的受试者未观察到明显的体积变化。
奥氮平可逆转典型抗精神病药物引起的壳核和苍白球增大，但不会改变先前接受利培酮治疗患者的体积。与典型和非典型抗精神病药物相关的纹状体体积变化可能代表个体药物与独特患者特征之间的相互作用。
