Chan Jenifer, Sweeting Melinda
South London and Maudsley NHS Trust, Gerald Russell Eating Disorders Unit, Bethlem Royal Hospital, Beckenham, UK.
J Psychopharmacol. 2007 Aug;21(6):657-64. doi: 10.1177/0269881106071334. Epub 2006 Nov 8.
Use of combined antipsychotics for patients with treatment-resistant/refractory schizophrenia is common practice in psychiatry. The objective of this paper is to review the current literature on combining non-clozapine atypical antipsychotics as well as discussing the theoretical benefits and risks, and summarizing the implications for clinical practice. We found in cases of treatment-resistant schizophrenia, where clozapine is deemed inappropriate, combination therapy with non-clozapine atypical antipsychotics is a strategy worthy of consideration. Combinations using olanzapine with either amisulpride or risperidone--or quetiapine with risperidone--in theory act on different receptor profiles and in the limited data available have shown improvement in symptoms, been used most frequently, and on balance have more data on safety. Initial case reports suggest that aripiprazole combined with non-clozapine atypicals may worsen psychosis. The current literature, however, has significant limitations. For this reason, due to the lack of data on safety, caution is recommended. There needs to be further well-designed studies with the aim to specifically investigate the effects of combination therapy to allow the clinician to better balance the risks and benefits (both clinical and economical) of treatment.
在精神病学中，联合使用抗精神病药物治疗难治性/顽固性精神分裂症患者是常见的做法。本文的目的是回顾关于联合使用非氯氮平非典型抗精神病药物的当前文献，讨论其理论上的益处和风险，并总结对临床实践的启示。我们发现，在氯氮平被认为不适用的难治性精神分裂症病例中，联合使用非氯氮平非典型抗精神病药物是一个值得考虑的策略。奥氮平与氨磺必利或利培酮联合使用——或者喹硫平与利培酮联合使用——理论上作用于不同的受体谱，并且在现有有限的数据中已显示出症状改善，使用最为频繁，而且总体上有更多关于安全性的数据。最初的病例报告表明，阿立哌唑与非氯氮平非典型药物联合使用可能会使精神病症状恶化。然而，当前的文献有显著局限性。因此，由于缺乏安全性数据，建议谨慎使用。需要有进一步精心设计的研究，旨在专门调查联合治疗的效果，以便临床医生能够更好地权衡治疗的风险和益处（包括临床和经济方面）。
