Kennedy Annette, Tapp Andre, Kelly William S, Kilzieh Nael, Wood Amanda Ernst
VA Puget Sound Health Care System, Seattle, WA, USA.
Essent Psychopharmacol. 2006;7(1):1-14.
Antipsychotic medications, specifically the atypical agents, serve as first-line treatment options for patients with psychotic disorders, including individuals with schizophrenia or schizoaffective disorder. Atypical antipsychotics are also often prescribed off-label as either the primary treatment or as an adjunctive treatment for individuals with other disorders, including mood disorders without psychosis, behavioral disorders, and insomnia. Despite the generally superior side-effect profiles of atypical antipsychotics compared with typical antipsychotic agents, the atypicals have been associated with a number of serious side effects, including metabolic disorders, cardiovascular disorders, seizures, hyperprolactinemia, and movement disorders. This article offers a stepwise approach to the management of antipsychotic side effects: Abstinence, Anticipation, Reduction, and Treatment (AART). The steps in AART are hierarchical, but often overlap in the areas of risk prevention and minimization. The authors discuss issues relevant to each level of intervention and provide suggestions for integrating the AART approach into a comprehensive treatment plan. By incorporating this stepwise approach into their clinical decision-making process, prescribers may be able to optimize the risk:benefit ratio associated with the prescription of atypical antipsychotics.
抗精神病药物，特别是非典型抗精神病药物，是患有精神障碍患者的一线治疗选择，包括精神分裂症或分裂情感性障碍患者。非典型抗精神病药物也经常被超说明书用药，作为其他疾病患者的主要治疗药物或辅助治疗药物，这些疾病包括无精神病性症状的心境障碍、行为障碍和失眠。尽管与典型抗精神病药物相比，非典型抗精神病药物的副作用总体上更轻，但非典型抗精神病药物也与一些严重的副作用有关，包括代谢紊乱、心血管疾病、癫痫发作、高催乳素血症和运动障碍。本文提供了一种抗精神病药物副作用管理的逐步方法：戒断、预期、减少和治疗（AART）。AART的步骤是分层的，但在风险预防和最小化方面往往相互重叠。作者讨论了与每个干预水平相关的问题，并提供了将AART方法纳入综合治疗计划的建议。通过将这种逐步方法纳入临床决策过程，处方者或许能够优化与非典型抗精神病药物处方相关的风险效益比。
