Maine Medical Center Research Institute, Scarborough, ME, USA.
Neuropsychiatr Dis Treat. 2010 Nov 10;6:749-66. doi: 10.2147/NDT.S6614.
Severe and persistent mental illnesses in children and adolescents, such as early- onset schizophrenia spectrum (EOSS) disorders and pediatric bipolar disorder (pedBP), are increasingly recognized. Few treatments have demonstrated efficacy in rigorous clinical trials. Enduring response to current medications appears limited. Recently, olanzapine was approved for the treatment of adolescents with schizophrenia or acute manic/mixed episodes in pedBP.
PubMed searches were conducted for olanzapine combined with pharmacology, schizophrenia, or bipolar disorder. Searches related to schizophrenia and bipolar disorder were limited to children and adolescents. The bibliographies of the retrieved articles were hand-checked for additional relevant studies. The epidemiology, phenomenology, and treatment of EOSS and pedBP, and olanzapine's pharmacology are reviewed. Studies of olanzapine treatment in youth with EOSS and pedBP are examined.
Olanzapine is efficacious for EOSS and pedBP. However, olanzapine is not more efficacious than risperidone, molindone, or haloperidol in EOSS and is less efficacious than clozapine in treatment-resistant EOSS. No comparative trials have been done in pedBP. Olanzapine is associated with weight gain, dyslipidemia, and transaminase elevations in youth. Extrapyramidal symptoms, neuroleptic malignant syndrome, and blood dyscrasias have also been reported but appear rare.
The authors conclude that olanzapine should be considered a second-line agent in EOSS and pedBP due to its risks for significant weight gain and lipid dysregulation. Awareness of the consistent weight and metabolic changes observed in olanzapine-treated youth focused attention on the potential long-term risks of atypical antipsychotics in youth.
儿童和青少年中严重且持续的精神疾病，如早期发病的精神分裂症谱系（EOS）障碍和儿童双相情感障碍（pedBP），越来越受到关注。很少有治疗方法在严格的临床试验中显示出疗效。目前药物的持久反应似乎有限。最近，奥氮平被批准用于治疗青少年精神分裂症或 pedBP 中的急性躁狂/混合发作。
在 PubMed 上进行了奥氮平与药理学、精神分裂症或双相情感障碍相结合的搜索。与精神分裂症和双相情感障碍相关的搜索仅限于儿童和青少年。检索文章的参考文献也进行了手工检查，以获取其他相关研究。综述了 EOS 和 pedBP 的流行病学、表现和治疗以及奥氮平的药理学。检查了奥氮平治疗青少年 EOS 和 pedBP 的研究。
奥氮平对 EOS 和 pedBP 有效。然而，在 EOS 中，奥氮平并不比利培酮、莫林酮或氟哌啶醇更有效，在治疗抵抗的 EOS 中比氯氮平更无效。在 pedBP 中没有进行过比较试验。奥氮平与青少年体重增加、血脂异常和转氨酶升高有关。也有报道称出现了锥体外系症状、恶性神经阻滞剂综合征和血液疾病，但似乎很少见。
作者认为，由于奥氮平有导致体重显著增加和脂质失调的风险，因此应将其视为 EOS 和 pedBP 的二线药物。奥氮平治疗青少年持续体重和代谢变化的意识引起了人们对非典型抗精神病药物在青少年中潜在长期风险的关注。
