Miura Itaru, Takeuchi Satoshi, Katsumi Akihiko, Kanno Keiko, Watanabe Kenya, Mashiko Hirobumi, Niwa Shin-Ichi
Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, Fukushima, Japan.
Hum Psychopharmacol. 2012 Sep;27(5):517-20. doi: 10.1002/hup.2251. Epub 2012 Aug 23.
In the treatment of acute schizophrenia, risperidone and aripiprazole are both placed the first line antipsychotics. These two antipsychotics have different pharmacological effects. We investigated the effects of risperidone on plasma levels of homovanillic acid (HVA) and 3-methoxy-4hydroxyphenylglycol after unsuccessful aripiprazole treatment in acute schizophrenia.
Ten Japanese patients with acute schizophrenia were enrolled to this study. Plasma levels of monoamine metabolites were analyzed with high-performance liquid chromatography with electrochemical detection.
Risperidone improved the symptoms and 4 of 10 patients were responders. Risperidone showed a tendency to decrease plasma HVA (pHVA) levels in responders (p = 0.068), but not in non-responders (p = 1.0). At baseline, pHVA levels of responders were significantly higher than that of non-responders (p = 0.033). A trend for negative correlation was found between pHVA at baseline and the changes in Positive and Negative Syndrome Scale-Total (p = 0.061, r = -0.61).
Our results suggest that high pHVA level before switching may predict good response to the second line antipsychotics after unsuccessful first antipsychotic treatment. If aripiprazole is not effective in acute schizophrenia, switching to risperidone may be effective and reasonable strategy for improving symptoms.
在急性精神分裂症的治疗中，利培酮和阿立哌唑均被列为一线抗精神病药物。这两种抗精神病药物具有不同的药理作用。我们研究了在急性精神分裂症患者阿立哌唑治疗失败后，利培酮对血浆高香草酸（HVA）和3-甲氧基-4-羟基苯乙二醇水平的影响。
十名日本急性精神分裂症患者纳入本研究。采用高效液相色谱电化学检测法分析单胺代谢产物的血浆水平。
利培酮改善了症状，10名患者中有4名有效。利培酮在有效者中显示出血浆HVA（pHVA）水平有下降趋势（p = 0.068），但在无效者中无此趋势（p = 1.0）。基线时，有效者的pHVA水平显著高于无效者（p = 0.033）。在基线时的pHVA与阳性和阴性症状量表总分的变化之间发现有负相关趋势（p = 0.061，r = -0.61）。
我们的结果表明，换药前高pHVA水平可能预示着在第一种抗精神病药物治疗失败后对第二种抗精神病药物有良好反应。如果阿立哌唑对急性精神分裂症无效，换用利培酮可能是改善症状的有效且合理策略。
