Ruedrich S L, Swales T P, Rossvanes C, Diana L, Arkadiev V, Lim K
Case School of Medicine - Psychiatry, MetroHealth Medical Center, Cleveland, OH 44109, USA.
J Intellect Disabil Res. 2008 Feb;52(Pt 2):132-40. doi: 10.1111/j.1365-2788.2007.00981.x.
Atypical antipsychotic medications have largely supplanted their typical counterparts, both for psychosis and for the treatment of aggression and/or self-injurious behaviour (SIB), in persons with intellectual disabilities (ID). However, with the exception of risperidone, little systematic research supports their use in such persons.
A retrospective review of 31 adult residents of a state developmental centre, who were treated for aggression and/or SIB with atypical antipsychotics. Average monthly counts of aggression and SIB for 1 year of treatment with typical antipsychotics, were compared with monthly averages for the next 12 months of treatment with atypical antipsychotics.
Twenty-seven of 31 subjects (87%) completed a full year of atypical antipsychotic treatment. Subjects ranged in age from 24 to 54 years (mean = 39); 18/31 (58%) had profound ID. Twelve of 26 (46%) had typical antipsychotics discontinued within the year of atypical treatment; another 7/26 (27%) had their typical antipsychotic dose decreased. Twenty-three of 31 trials involved risperidone; 7/31 olanzapine; 1/31 quetiapine. Subjects gained an average of 6.6 pounds during the year of atypical treatment, but no significant changes in glucose or cholesterol were found. Subjects with aggression alone (N = 14) had significant decreases in the number of aggressive acts per month during the year of atypical treatment (P = 0.03); those with both aggression and self-injury (N = 12), or those with self-injury alone (N = 5) had no significant improvement.
The findings suggest that atypical antipsychotics can be successfully substituted for typical agents in individuals with ID and decrease the frequency of aggression over one year of treatment. The weight gain seen in our sample reinforces the necessity of regular monitoring of weight and metabolic changes in persons with ID treated with atypical antipsychotics.
在智障人士中，非典型抗精神病药物在很大程度上已取代了传统抗精神病药物，用于治疗精神病以及攻击行为和/或自伤行为（SIB）。然而，除利培酮外，几乎没有系统研究支持在这类人群中使用非典型抗精神病药物。
对31名州立发展中心的成年居民进行回顾性研究，这些居民接受了非典型抗精神病药物治疗以控制攻击行为和/或自伤行为。将使用传统抗精神病药物治疗1年期间攻击行为和自伤行为的月平均次数，与随后使用非典型抗精神病药物治疗的12个月的月平均值进行比较。
31名受试者中有27名（87%）完成了一整年的非典型抗精神病药物治疗。受试者年龄在24至54岁之间（平均 = 39岁）；31名中有18名（58%）有严重智障。26名中有12名（46%）在非典型治疗的一年内停用了传统抗精神病药物；另外7名（27%）的传统抗精神病药物剂量减少。31项试验中有23项涉及利培酮；7项涉及奥氮平；1项涉及喹硫平。在非典型治疗的一年中，受试者平均体重增加了6.6磅，但未发现血糖或胆固醇有显著变化。仅表现出攻击行为的受试者（N = 14）在非典型治疗的一年中每月攻击行为的次数显著减少（P = 0.03）；同时有攻击行为和自伤行为的受试者（N = 12），或仅有自伤行为的受试者（N = 5）没有显著改善。
研究结果表明，非典型抗精神病药物可以成功替代智障人士中的传统药物，并在一年的治疗中降低攻击行为的频率。我们样本中出现的体重增加强化了对接受非典型抗精神病药物治疗的智障人士定期监测体重和代谢变化的必要性。
