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精神分裂症的治疗。抗精神病药物及其作用机制的批判性综述。

Schizophrenia treatment. Critical review on the drugs and mechanisms of action of antipsychotics.

作者信息

Tajima K, Fernández H, López-Ibor J L, Carrasco José Luis, Díaz-Marsá M

机构信息

Hospital Clínico San Carlos, Madrid, Spain.

出版信息

Actas Esp Psiquiatr. 2009 Nov-Dec;37(6):330-42.

Abstract

Schizophrenic treatment was developed during the second half of the last century, mainly within the context of the development of antipsychotic drugs. Even though there has been significant progress due to the availability and use of multiple drugs, these can still be classified into three basic groups of antipsychotic drugs (atypical antipsychotics, typical antipsychotics and dopamine partial agonist antipsychotics). Their primary antipsychotic mechanism is still the action on the dopamine systems. Many of the second-generation antipsychotics are believed to offer advantages over first-generation agents in the treatment for schizophrenia. However, the drug properties that provide the different therapeutic effects from those of the first generation are not clear and some adverse effects may still affect the patient's health and quality of life. Furthermore, the efficacy of the antipsychotics is limited. This has led to the use of adjuvant medications to strengthen the treatment effects. On the other hand, work is being done on the development of new research lines to develop new non-dopaminergic antipsychotic drugs, with not very successful results. The aim of this paper is to make a brief review on the current therapeutic armamentarium for schizophrenia, the strategies to develop drugs, and theories of mechanisms of action of antipsychotics. Emphasis is placed on the new therapeutic targets for the development of future treatments.

摘要

精神分裂症的治疗是在上个世纪下半叶发展起来的,主要是在抗精神病药物发展的背景下。尽管由于多种药物的可得性和使用取得了显著进展,但这些药物仍可分为三类基本的抗精神病药物(非典型抗精神病药物、典型抗精神病药物和多巴胺部分激动剂抗精神病药物)。它们的主要抗精神病机制仍然是作用于多巴胺系统。许多第二代抗精神病药物被认为在治疗精神分裂症方面比第一代药物具有优势。然而,提供与第一代药物不同治疗效果的药物特性尚不清楚,一些不良反应仍可能影响患者的健康和生活质量。此外,抗精神病药物的疗效有限。这导致使用辅助药物来增强治疗效果。另一方面,正在开展新的研究方向以开发新的非多巴胺能抗精神病药物,但结果不太成功。本文的目的是对精神分裂症目前的治疗手段、药物开发策略以及抗精神病药物的作用机制理论进行简要综述。重点是未来治疗开发的新治疗靶点。

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