Handen Benjamin L, Hardan Antonio Y
Dr. Handen is with the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic; and Dr. Hardan is with the Stanford University School of Medicine..
Dr. Handen is with the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic; and Dr. Hardan is with the Stanford University School of Medicine.
J Am Acad Child Adolesc Psychiatry. 2006 Aug;45(8):928-935. doi: 10.1097/01.chi.0000223312.48406.6e.
Olanzapine, an atypical antipsychotic, has been shown to be efficacious for treatment of psychotic and mood disorders in adults. This prospective, open-label study was conducted to examine the safety and usefulness of olanzapine in treating disruptive behavior disorders in adolescents with subaverage intelligence.
Sixteen adolescents (ages 13-17 years) with borderline to moderate mental retardation and disruptive behavior were enrolled in an 8-week olanzapine trial (5-20 mg/day). Dependent measures included the Aberrant Behavior Checklist, Conners Parent Rating Scale, Clinical Global Impressions, and two side effects scales.
Statistically significant improvement (p <.002) was found on the Irritability and Hyperactivity subscales of the Aberrant Behavior Checklist and the Conners Parent Rating Scale Hyperactivity Index. No subjects developed extrapyramidal side effects. However, four were terminated prematurely from the trial because of either worsening of symptoms (requiring psychiatric inpatient hospitalization in two subjects) or side effects. The most common side effect for the sample was weight gain (averaging 12.7 lb), with 67% of subjects gaining > or =10 lb. Although there was also a statistically significant increase in prolactin levels, no subjects reported prolactin-related side effects (e.g., gynecomastia, galactorhea, amenorrhea).
Olanzapine may be useful in treating disruptive behavior in adolescents with subaverage intelligence. However, side effects, especially weight gain, are a significant issue. Future double-blind, placebo-controlled studies need to confirm these findings and assess long-term safety and outcome of olanzapine treatment.
奥氮平是一种非典型抗精神病药物，已被证明对治疗成人的精神病性和情绪障碍有效。本前瞻性、开放标签研究旨在检验奥氮平治疗智力低于平均水平青少年的破坏性行为障碍的安全性和有效性。
16名年龄在13至17岁、患有边缘性至中度智力发育迟缓及破坏性行为的青少年参加了一项为期8周的奥氮平试验（5 - 20毫克/天）。相关测量指标包括异常行为检查表、康纳斯父母评定量表、临床总体印象以及两个副作用量表。
在异常行为检查表的易激惹和多动子量表以及康纳斯父母评定量表多动指数上发现有统计学意义的改善（p <.002）。没有受试者出现锥体外系副作用。然而，有4名受试者因症状恶化（其中2名需要住院接受精神科治疗）或副作用而提前退出试验。该样本中最常见的副作用是体重增加（平均增加12.7磅），67%的受试者体重增加≥10磅。虽然催乳素水平也有统计学意义的升高，但没有受试者报告与催乳素相关的副作用（如男子女性型乳房、溢乳、闭经）。
奥氮平可能对治疗智力低于平均水平青少年的破坏性行为有用。然而，副作用，尤其是体重增加，是一个重要问题。未来需要进行双盲、安慰剂对照研究来证实这些发现，并评估奥氮平治疗的长期安全性和结果。
