Bordet R
EA1046, département de pharmacologie médicale, faculté de médecine, université Lille 2, 1, place de Verdun, 59045, Lille cedex, France; CHU de Lille, 2, avenue Oscar-Lambret, 59000, Lille, France.
Encephale. 2015 Feb;41(1):39-46. doi: 10.1016/j.encep.2014.12.001. Epub 2015 Jan 28.
Antipsychotics are, by definition, drugs to treat all symptomatic dimensions of schizophrenia, even if, following the discovery of chlorpromazine, the effect assessment has been focused on the ability to reduce positive symptoms. Nevertheless, expectations of treatment are no longer limited to only support this one dimension, but integrate the need to treat negative, cognitive and affective symptoms, through long-term modulation of dopamine transmission but also non-dopaminergic pathways. Beyond symptomatic treatment, it is also necessary to have a treatment modifying the evolution course of the disease (disease modifier), acting by a long-term effect on neuropathological and neurochemical abnormalities. The limitation of long-term effect remains the issue of therapeutic observance. Moreover, this concern for efficiency should be at the cost of reduced induction of adverse effects to maximize the benefit/risk ratio. All these dimensions should the components to profile an ideal antipsychotic treatment in 2015.
从定义上讲,抗精神病药物是用于治疗精神分裂症所有症状维度的药物,即便在氯丙嗪被发现之后,疗效评估主要集中在减轻阳性症状的能力上。然而,治疗期望不再局限于仅支持这一个维度,而是通过长期调节多巴胺传递以及非多巴胺能途径,将治疗阴性、认知和情感症状的需求整合进来。除了症状治疗,还需要有一种能改变疾病演变进程的治疗方法(疾病修饰剂),通过对神经病理和神经化学异常产生长期作用来发挥功效。长期疗效的局限性仍然是治疗依从性的问题。此外,这种对疗效的关注应以减少不良反应的诱发为代价,以最大化效益/风险比。所有这些维度都应成为勾勒2015年理想抗精神病治疗方案的组成部分。