Wolkowitz O M, Pickar D
Department of Psychiatry, University of California, School of Medicine, San Francisco.
Am J Psychiatry. 1991 Jun;148(6):714-26. doi: 10.1176/ajp.148.6.714.
Benzodiazepines, either alone or added to neuroleptics, have been studied extensively as treatments for schizophrenia, but no consensus regarding their efficacy has been reached. The authors review the double-blind trials in the literature and relate the findings to the neurobiology of benzodiazepine actions.
The clinical review included all double-blind studies through 1989 that could be identified by means of Index Medicus and computer-assisted searches and by the cross-referencing of articles. The findings from the 14 studies of benzodiazepines used alone and the 16 studies of adjunctive therapy are presented separately.
The studies reviewed suggest that 1) response is highly variable, and about one-third to one-half of patients improve; 2) benzodiazepines are potentially most useful as adjuncts to neuroleptics in the acute management of psychotic agitation, although actual antipsychotic effects have also been observed in some patients; 3) relatively higher doses of benzodiazepines may be associated with better response; and 4) therapeutic effects, when seen, develop rapidly but diminish after several weeks in some patients. The authors explore the neurobiological bases of benzodiazepine action, which presumably underlie their efficacy in schizophrenia and may help explain the variability of response.
Future research on benzodiazepines in the treatment of schizophrenia should focus on features that predict response, the relation of dopamine or other neurotransmitter systems to therapeutic effects, the schizophrenic symptoms most amenable to benzodiazepine treatment, changes in neuroleptic dose during benzodiazepine augmentation, the role of benzodiazepines in maintenance therapy, and the optimal characteristics of benzodiazepine treatment.
苯二氮䓬类药物单独使用或与抗精神病药物联合使用，已被广泛研究用于治疗精神分裂症，但关于其疗效尚未达成共识。作者回顾了文献中的双盲试验，并将研究结果与苯二氮䓬类药物作用的神经生物学联系起来。
临床综述纳入了所有截至1989年的双盲研究，这些研究可通过医学索引和计算机辅助检索以及文章交叉引用得以识别。单独使用苯二氮䓬类药物的14项研究结果和辅助治疗的16项研究结果分别呈现。
所回顾的研究表明：1）反应差异很大，约三分之一至二分之一的患者病情改善；2）苯二氮䓬类药物在急性处理精神病性激越方面作为抗精神病药物的辅助用药可能最有用，尽管在一些患者中也观察到了实际的抗精神病作用；3）相对较高剂量的苯二氮䓬类药物可能与更好的反应相关；4）治疗效果一旦出现则发展迅速，但在一些患者中数周后会减弱。作者探讨了苯二氮䓬类药物作用的神经生物学基础，这可能是其在精神分裂症中疗效的基础，并可能有助于解释反应的变异性。
未来关于苯二氮䓬类药物治疗精神分裂症的研究应聚焦于预测反应的特征、多巴胺或其他神经递质系统与治疗效果的关系、最适合用苯二氮䓬类药物治疗的精神分裂症症状、在苯二氮䓬类药物增效期间抗精神病药物剂量的变化、苯二氮䓬类药物在维持治疗中的作用以及苯二氮䓬类药物治疗的最佳特性。
