Gardner David M, Baldessarini Ross J, Waraich Paul
Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, NS.
CMAJ. 2005 Jun 21;172(13):1703-11. doi: 10.1503/cmaj.1041064.
Conventional antipsychotic drugs, used for a half century to treat a range of major psychiatric disorders, are being replaced in clinical practice by modern "atypical" antipsychotics, including aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone among others. As a class, the newer drugs have been promoted as being broadly clinically superior, but the evidence for this is problematic. In this brief critical overview, we consider the pharmacology, therapeutic effectiveness, tolerability, adverse effects and costs of individual modern agents versus older antipsychotic drugs. Because of typically minor differences between agents in clinical effectiveness and tolerability, and because of growing concerns about potential adverse long-term health consequences of some modern agents, it is reasonable to consider both older and newer drugs for clinical use, and it is important to inform patients of relative benefits, risks and costs of specific choices.
传统抗精神病药物用于治疗一系列主要精神疾病已有半个世纪之久，但在临床实践中，它们正被现代“非典型”抗精神病药物所取代，其中包括阿立哌唑、氯氮平、奥氮平、喹硫平、利培酮和齐拉西酮等。作为一个类别，新型药物在临床上被广泛宣传为具有更显著的优势，但支持这一观点的证据存在问题。在这篇简短的批判性综述中，我们比较了各类现代药物与传统抗精神病药物在药理学、治疗效果、耐受性、不良反应和成本方面的差异。由于各类药物在临床疗效和耐受性方面的差异通常较小，并且人们对某些现代药物潜在的长期健康不良后果越来越担忧，因此在临床使用中考虑使用传统药物和新型药物都是合理的，而且让患者了解特定选择的相对益处、风险和成本也很重要。
