Mucci Armida, Volpe Umberto, Merlotti Eleonora, Bucci Paola, Galderisi Silvana
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Clin EEG Neurosci. 2006 Apr;37(2):81-98. doi: 10.1177/155005940603700206.
In spite of its origins deeply rooted in the discipline, pharmaco-EEG applications in psychiatry remain limited to its achievements in the field of psychotropic drugs classification and, in few instances, discovery. In the present paper two attempts to transfer pharmaco-EEG methods to psychiatric clinical routine will be described: 1) monitoring of psychotropic drug toxicity at the central nervous system level, and 2) prediction of clinical response to treatment with psychotropic drugs. Both applications have been the object of several investigations providing promising and sometimes consistent findings which, however, had no impact on clinical practice. For the first topic, the review is limited to antipsychotics, lithium and recreational drugs, as for other psychotropic drugs mostly case studies are available, while for the response prediction it will include antipsychotics, antidepressants, anxiolytics, psychostimulants and nootropics. In spite of several methodological limitations, pharmaco-EEG studies dealing with monitoring of antipsychotic- and lithium-induced EEG abnormalities went close to, but never became, a clinical routine. EEG studies of recreational drugs are flawed by several limitations, and failed, so far, to identify reliable indices of CNS toxicity to be used in clinical settings. Several QEEG studies on early predictors of treatment response to first generation antipsychotics have produced consistent findings, but had no clinical impact. For other psychotropic drug classes few and inconsistent reports have appeared. Pharmaco-EEG had the potential for important clinical applications, but so far none of them entered clinical routine. The ability to upgrade theories and methods and promote large scale studies represent the future challenge.
尽管药物脑电图起源于该学科且根基深厚，但在精神病学中的应用仍局限于其在精神药物分类领域的成果，在少数情况下也涉及发现新药物。在本文中，将描述两项把药物脑电图方法应用于精神病临床常规的尝试：1）在中枢神经系统层面监测精神药物毒性；2）预测精神药物治疗的临床反应。这两项应用都已成为多项研究的对象，这些研究提供了有前景且有时一致的结果，然而，这些结果对临床实践并无影响。对于第一个主题，综述限于抗精神病药物、锂盐和消遣性药物，因为对于其他精神药物大多只有个案研究，而对于反应预测，将包括抗精神病药物、抗抑郁药物、抗焦虑药物、精神兴奋剂和益智药。尽管存在一些方法学上的局限性，但关于监测抗精神病药物和锂盐所致脑电图异常的药物脑电图研究已接近临床常规，但从未真正成为临床常规。消遣性药物的脑电图研究存在若干局限性，并且迄今为止未能确定可用于临床环境的可靠中枢神经系统毒性指标。多项关于第一代抗精神病药物治疗反应早期预测指标的定量脑电图研究得出了一致的结果，但对临床没有影响。对于其他精神药物类别，出现的报告很少且不一致。药物脑电图有重要临床应用的潜力，但迄今为止，这些应用均未进入临床常规。提升理论和方法以及推动大规模研究的能力是未来的挑战。
