Division of Psychiatry, Haukeland University Hospital, and Section of Psychiatry, Department of Clinical Medicine, University of Bergen, Sandviksleitet 1, N-5035 Bergen, Norway.
Ther Adv Chronic Dis. 2012 Nov;3(6):287-300. doi: 10.1177/2040622312462275.
Schizophrenia and bipolar disorder are often highly debilitating with chronic courses, and psychotropic drugs represent cornerstones in the treatment. The primary aim of the review was to summarize the latest evidence with regards to the efficacy and effectiveness of drug treatment of schizophrenia and the manic phases of bipolar disorder. Schizophrenia systematic reviews conclude that antipsychotic drugs are effective in treating overall symptoms of psychosis and in preventing relapse. Some of the newer agents, the second-generation antipsychotics (SGAs), have demonstrated superiority compared with the older first-generation drugs and other SGAs but side-effect differences among the drugs are of a greater magnitude than effect differences. The pragmatic randomized trials of effectiveness have shown a longer time until treatment discontinuation for olanzapine compared with other antipsychotics. Cohort studies have found superiority for the long-acting injection formulations compared with the oral formulations of the drugs, and lower total mortality risk in users of antipsychotics compared with non-users. In bipolar mania SGAs have shown superior antimanic efficacy compared with other mood-stabilizing drugs. In conclusion antipsychotics, in particular some of the SGAs, seem to be drugs of first choice for both schizophrenia and bipolar mania. This perspective review focused on mean effects but the group means may not always be particularly useful as schizophrenia and bipolar mania are biologically heterogeneous disorders with large inter-individual variations in drug response and tolerance. In patients with a prior drug history the different pharmacological and clinical profiles may be exploited in subsequent choices of drugs.
精神分裂症和双相情感障碍常伴有慢性病程，使人高度致残，精神药物是其治疗的基石。本综述的主要目的是总结精神分裂症和双相情感障碍躁狂发作药物治疗的最新疗效和有效性证据。精神分裂症系统评价的结论是，抗精神病药物对治疗精神病的总体症状和预防复发有效。一些较新的药物，即第二代抗精神病药（SGAs），与第一代较老的药物和其他 SGAs 相比具有优越性，但药物之间的副作用差异大于疗效差异。关于有效性的实用随机试验表明，与其他抗精神病药物相比，奥氮平治疗的停药时间更长。队列研究发现，长效注射制剂比药物的口服制剂具有优越性，且使用抗精神病药物的患者总死亡率低于未使用者。在双相情感障碍躁狂症中，SGAs 显示出比其他情绪稳定剂更好的抗躁狂疗效。总之，抗精神病药，特别是一些 SGAs，似乎是精神分裂症和双相情感障碍躁狂症的首选药物。本综述重点关注平均效应，但群体均值并不总是特别有用，因为精神分裂症和双相情感障碍躁狂症是生物学异质性疾病，药物反应和耐受性存在很大的个体间差异。对于有既往药物史的患者，不同的药理学和临床特征可能会在随后的药物选择中得到利用。
