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为什么医生仍在开抗精神病药物?

Why are doctors still prescribing neuroleptics?

作者信息

Charlton B G

机构信息

School of Biology and Psychology, University of Newcastle upon Tyne, Newcastle upon Tyne NE1 7RU, UK.

出版信息

QJM. 2006 Jun;99(6):417-20. doi: 10.1093/qjmed/hcl048.

Abstract

There are two main pharmacological methods of suppressing undesired behaviour: sedation or neuroleptics. Traditionally, the invention of neuroleptics has been hailed as one of the major clinical breakthroughs of the twentieth century, since they calmed agitation without (necessarily) causing sedation. The specifically neuroleptic form of behavioural control is achieved by making patients psychologically Parkinsonian, which entails emotional blunting and consequent demotivation. Furthermore, chronic neuroleptic usage creates dependence, so that in the long term, neuroleptics are doing most patients more harm than good. The introduction of 'atypical' neuroleptics (neuroleptically-weak but strongly sedative neuroleptics) has made only a difference in degree, and at the cost of a wide range of potentially fatal metabolic and other side-effects. For half a century, the creation of millions of Parkinsonian patients may have been misinterpreted as a 'cure' for schizophrenia. Such a wholesale re-interpretation of neuroleptic therapy represents an unprecedented disaster for the self-image and public reputation of both psychiatry and the whole medical profession. Nonetheless, except as a last resort, neuroleptics should swiftly be replaced by gentler and safer sedatives.

摘要

抑制不良行为主要有两种药理学方法

镇静或使用抗精神病药物。传统上,抗精神病药物的发明被誉为20世纪的重大临床突破之一,因为它们能平息躁动而(不一定)引起镇静。特定的抗精神病药物形式的行为控制是通过使患者在心理上呈现帕金森氏症状态来实现的,这会导致情感迟钝并进而导致动力缺失。此外,长期使用抗精神病药物会产生依赖性,所以从长远来看,抗精神病药物对大多数患者弊大于利。“非典型”抗精神病药物(抗精神病作用弱但镇静作用强的抗精神病药物)的引入只是在程度上有所不同,且代价是一系列潜在的致命代谢及其他副作用。半个世纪以来,数百万帕金森氏症患者的产生可能被误解为对精神分裂症的“治愈”。这种对抗精神病药物疗法的全面重新解读对精神病学和整个医学专业的自我形象及公众声誉而言是一场前所未有的灾难。尽管如此,除非作为最后手段,抗精神病药物应迅速被更温和、更安全的镇静剂所取代。

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