University Department of Psychiatry, Clinical Hospital Centre Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
Psychiatr Danub. 2009 Dec;21(4):446-52.
There has been significant confusion about the relative advantage of new generation antipsychotics over first generation antipsychotics as well as of clinical trials performed to evaluate their efficacy vs. those designed to evaluate their effectiveness. Pragmatic or effectiveness clinical trials like CATIE and CUtLASS sponsored by governments have challenged the current worldview of the greater advantages of new generation over first generation antipsychotics and suggested more clinical applicability of older antipsychotics. Public policy regarding the role and place of modern antipsychotics in schizophrenia treatment is usually guided by the imperfect state of clinical trials and by economic constraints. The right question is not whether new generation antipsychotics are better than first generation antipsychotics in terms of effectiveness, tolerability and safety. How to reach personalized , evidence based and value oriented decision making in the complex treatment of schizophrenia and other psychotic disorders, that is the question now. Personalized medicine in psychiatry is not possible without the availability of enough number of different modern antipsychotics.
关于新一代抗精神病药相对于第一代抗精神病药的相对优势，以及为评估其疗效而进行的临床试验与为评估其效果而进行的临床试验之间，存在着很大的混淆。由政府资助的实用或效果临床试验，如 CATIE 和 CUtLASS，对新一代抗精神病药优于第一代抗精神病药的当前世界观提出了挑战，并表明更老的抗精神病药更具有临床适用性。关于现代抗精神病药在精神分裂症治疗中的作用和地位的公共政策，通常是由临床试验的不完善状态和经济限制所决定的。正确的问题不是新一代抗精神病药在疗效、耐受性和安全性方面是否优于第一代抗精神病药。现在的问题是，如何在精神分裂症和其他精神病性障碍的复杂治疗中做出个性化、基于证据和具有价值导向的决策。没有足够数量的不同现代抗精神病药，精神病学的个性化医疗是不可能的。
