Takeuchi Hiroyoshi
Seishin Shinkeigaku Zasshi. 2015;117(7):562-7.
While antipsychotic treatment is essential for acute and maintenance phases of schizophrenia, antipsychotics can induce various undesirable side effects. Thus, antipsychotic dose and dosing interval should be optimized for each patient. Some of the side effects of antipsychotics, including cognitive impairment, are related to antipsychotic dose. To date, there have been only a few studies examining the effect of atypical antipsychotic dose reduction on clinical outcomes, and there has been no study employing neurocognitive assessments. Based on this background, we conducted a randomized controlled trial and found that atypical antipsychotic reduction significantly improved cognitive function without an increased risk of relapse. In addition, we analyzed the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) data, revealing that there were no significant differences in clinical outcomes between once- vs. twice-daily perphenazine dosing regimens; however, the mean dose of perphenazine was significantly lower with once-daily dosing than that with twice-daily dosing. These findings suggest the possibility of effective antipsychotic treatment with lower doses and longer dosing intervals.
虽然抗精神病药物治疗对于精神分裂症的急性期和维持期至关重要,但抗精神病药物会引发各种不良副作用。因此,应针对每位患者优化抗精神病药物的剂量和给药间隔。抗精神病药物的一些副作用,包括认知障碍,与抗精神病药物剂量有关。迄今为止,仅有少数研究考察了非典型抗精神病药物剂量降低对临床结局的影响,且尚无研究采用神经认知评估。基于此背景,我们开展了一项随机对照试验,发现降低非典型抗精神病药物剂量可显著改善认知功能,且复发风险并未增加。此外,我们分析了临床抗精神病药物干预有效性试验(CATIE)的数据,结果显示,每日一次与每日两次奋乃静给药方案的临床结局无显著差异;然而,每日一次给药时奋乃静的平均剂量显著低于每日两次给药时的剂量。这些发现表明,使用较低剂量和较长给药间隔进行有效的抗精神病药物治疗具有可能性。