Surja Anton A Subuh, Tamas Rebecca L, El-Mallakh Rif S
Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
Curr Drug Targets. 2006 Sep;7(9):1217-24. doi: 10.2174/138945006778226598.
Antipsychotic medications have been used to treat acute phases, and prevent relapses in, bipolar illness since their introduction into psychiatric practice. With the introduction of second generation antipsychotic medications, there has been renewed interest in the utility of this class of medications in managing manic-depression. It appears that all antipsychotic agents investigated have a potent acute antimanic property. This has been shown both in monotherapy and in combination with traditional mood stabilizing medications. The first generation antipsychotics appeared to worsen depression or induce a depressive-like state, but the second generation agents do not have this property and may have some antidepressant properties in bipolar patients. There is a dearth of controlled long term studies, but in open studies, both first and second generation agents appear to have a beneficial effect. Second generation antipsychotic agents appear to be a useful tool that may benefit bipolar patients. Adverse consequences of this group of medications appear to be the major limiting factors to their use. Antipsychotic medications play a very important role in the treatment of bipolar illness. This has become especially true since the introduction of second generation agents. There is a wealth of data documenting the use of these agents in bipolar mania. There are fewer studies examining relapse prevention. Finally, there are a small number of interesting studies suggesting utility in bipolar depression. This paper will critically review available randomized clinical trials utilizing antipsychotic agents in bipolar disorder.
自抗精神病药物被引入精神科治疗以来，一直被用于治疗双相情感障碍的急性期并预防复发。随着第二代抗精神病药物的出现，人们对这类药物在治疗躁狂抑郁症方面的效用重新产生了兴趣。似乎所有被研究的抗精神病药物都具有强效的急性抗躁狂特性。这在单药治疗以及与传统心境稳定剂联合使用时均得到了证实。第一代抗精神病药物似乎会加重抑郁或诱发类似抑郁的状态，但第二代药物没有这种特性，并且在双相情感障碍患者中可能具有一些抗抑郁特性。目前缺乏对照的长期研究，但在开放性研究中，第一代和第二代药物似乎都有有益效果。第二代抗精神病药物似乎是一种可能使双相情感障碍患者受益的有用工具。这类药物的不良反应似乎是其使用的主要限制因素。抗精神病药物在双相情感障碍的治疗中起着非常重要的作用。自第二代药物问世以来尤其如此。有大量数据记录了这些药物在双相躁狂中的应用。而关于预防复发的研究较少。最后，有少数有趣的研究表明其在双相抑郁中也有作用。本文将批判性地综述在双相情感障碍中使用抗精神病药物的现有随机临床试验。
