Specialized Hospital for Psychiatric Disorders Gornja Toponica, 18202 Gornja Toponica, Niš, Serbia.
Psychiatr Danub. 2011 Dec;23(4):384-8.
Schizophrenia is a severe chronic psychiatric disorder for which treatment compliance is important in the prevention of relapse. Second generation antipsychotics (SGA), such as Risperidone, have been found to be more effective in the treatment of such patients than the high potency first generation antipsychotics (FGA). This is an open study where the same group of patients was first treated with FGA and then were switched to Risperidone, in controlled hospital conditions, after a wash- out period. The aim of the study was to examine whether patients with schizophrenia who were judged to be stable on long-term treatment with FGA would further benefit from a switch to an atypical antipsychotic drug.
Eighty hospitalized patients suffering from Schizophrenia or Schizoaffective disorder (male 54, female 26) were first treated with Haloperidol (N=60) or Fluphenazine (N=20), and then were switched to Risperidone. Their clinical state was monitored using the PANSS scale for Schizophrenia, measuring the Total PANSS score. The KLAWANS scale for assessment of extrapyramidal syndrome (EPS) was also used. Administration and dosage of Trihexiphenidil (THF) was recorded. The study lasted for 8 weeks, with 4 screenings (Visit 0-baseline- FGA, Visits 1-3 Risperidone on Day 14, 28 and 56, respectively).
The average age was 38. Patients usually suffered the paranoid form of Schizophrenia (55%). The duration of illness was more than 5 years (38.8%). During the eight- week trial on Risperidone, using the PANSS total scores, we observed clinical improvement where the therapy switch had caused an initial worsening (p<0.05). Also, the compared baseline (FGA) and last visit showed a low, but statistically significant benefit in favor of Risperidone (t=5.45, df=79, p<0.005). Intensity of EPS measured by KLAWANS scores significantly decreased during time (F=4.115; p=0.016; Partial Eta Square=0.058). Average Trihexiphenidil doses followed Risperidone in a dose dependent manner (r=0.748, r=0.661, respectively, p<0.01) with the consequent decrease of patients needing THF corrective therapy (68.8% at the baseline toward 22.5% on last visit).
Switch to Risperidone medication provided significant additional improvement in symptom severity, extrapyramidal side effects and need for anticholinergic medication. This suggests that one might expect better compliance in future treatment in this population of chronic schizophrenic patients.
精神分裂症是一种严重的慢性精神疾病，预防复发的关键在于提高治疗依从性。与高效价第一代抗精神病药物（FGA）相比，第二代抗精神病药物（SGA），如利培酮，在治疗此类患者方面更有效。这是一项开放性研究，同一组患者在停药期后，首先在受控医院环境下接受 FGA 治疗，然后换用利培酮。该研究的目的是检验长期使用 FGA 治疗后病情稳定的精神分裂症患者是否能从换用非典型抗精神病药物中进一步获益。
80 名患有精神分裂症或分裂情感障碍的住院患者（男性 54 名，女性 26 名）首先接受氟哌啶醇（N=60）或氟奋乃静（N=20）治疗，然后换用利培酮。使用精神分裂症阳性和阴性症状量表（PANSS）评估他们的临床状态，测量总 PANSS 评分。还使用 KLAWANS 量表评估锥体外系综合征（EPS）。记录三氟拉嗪（THF）的给药和剂量。该研究持续 8 周，共进行 4 次筛查（访视 0-基线-FGA，访视 1-3 分别为利培酮治疗的第 14、28 和 56 天）。
平均年龄为 38 岁。患者通常患有偏执型精神分裂症（55%）。病程超过 5 年（38.8%）。在使用 PANSS 总分进行的为期 8 周的利培酮治疗期间，我们观察到治疗转换引起的初始恶化后的临床改善（p<0.05）。此外，与基线（FGA）和最后一次访视相比，利培酮显示出低但具有统计学意义的益处（t=5.45，df=79，p<0.005）。通过 KLAWANS 评分测量的 EPS 强度随时间显著降低（F=4.115；p=0.016；部分 eta 平方=0.058）。三氟拉嗪的平均剂量随利培酮剂量呈依赖性变化（r=0.748，r=0.661，均为 p<0.01），这导致需要三氟拉嗪矫正治疗的患者人数减少（基线时为 68.8%，最后一次访视时为 22.5%）。
换用利培酮治疗可显著改善症状严重程度、锥体外系副作用和抗胆碱能药物的需求。这表明，在未来的治疗中，我们可能会期待这一慢性精神分裂症患者群体的更高依从性。
