Freudenreich Oliver, McEvoy Joseph P
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
Clin Schizophr Relat Psychoses. 2012 Oct;6(3):115-21. doi: 10.3371/CSRP.6.3.3.
The initial tailoring of antipsychotic medication for an individual experiencing a first episode of psychosis (FEP) is a critical empirical process with potentially far-reaching consequences. This article reviews the results of randomized treatment trials of clinically available first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in individuals experiencing FEP, addressing these medications' relative therapeutic potentials and their proclivities to produce a range of unwanted side effects. The authors will argue that the best clinical long-term outcomes will be achieved with: 1) a "succeed-first" strategy of identifying those treatment-responsive individuals who will have a good response to neuroleptic threshold doses of well-tolerated FGAs (thereby avoiding weight gain, insulin resistance, and prolactin-induced changes in gender-specific physiology); and, 2) an early trial of clozapine in treatment-nonresponsive FEP patients.
为首次发作精神病（FEP）患者初步定制抗精神病药物是一个关键的经验性过程，可能会产生深远影响。本文回顾了临床上可用的第一代抗精神病药物（FGA）和第二代抗精神病药物（SGA）针对FEP患者的随机治疗试验结果，探讨了这些药物的相对治疗潜力以及产生一系列不良副作用的倾向。作者认为，通过以下方式可实现最佳的临床长期疗效：1）采用“先成功”策略，即识别出那些对耐受性良好的FGA的抗精神病阈值剂量有良好反应的治疗反应性个体（从而避免体重增加、胰岛素抵抗以及催乳素引起的性别特异性生理变化）；2）对治疗无反应的FEP患者尽早试用氯氮平。
