Hoes M J
Acta Neuropsychiatr. 1999 Sep;11(3):85-92. doi: 10.1017/S0924270800036024.
Antipsychotic drugs are effective in psychoses, whatever the etiology of the disorder. The positive symptoms tend to respond more readily. The need for developing new drugs arises from the refractoriness of the negative symptoms, the 10-25% of the patients that are treatment-resistant and the problems of short-, and long-term extrapyramidal side-effects. Thus far, six drugs, differing from the classical antipsychotics, have been licensedfor use: olanzepine, risperidone and quetiapine; the longest registration exists for sulpiride and clozapine while the most recent one is for amisulpride. This review starts with a brief introduction to symptomatology, and takes differences with the classical drugs in pharmacology, pharmacokinetics, clinical aspects and side-effects into consideration. Clozapine, risperidone and sulpiride may be considered for clinical use in refractory patients; these three, olanzapine and amisulpride when extrapyramidal side-effects cause a clinical problem. Amisulpride and sulpiride have a dual therapeutic acion: On negative symptoms at low dose, on positive symptomen at high doses.
抗精神病药物对各种病因引起的精神病均有效。阳性症状往往更容易得到缓解。研发新药的需求源于阴性症状的难治性、10%至25%的难治性患者以及短期和长期锥体外系副作用问题。迄今为止，已有六种与经典抗精神病药物不同的药物获批使用：奥氮平、利培酮和喹硫平；舒必利和氯氮平的注册时间最长，而最近获批的是阿立哌唑。本综述首先简要介绍症状学，并考虑其在药理学、药代动力学、临床方面和副作用与经典药物的差异。氯氮平、利培酮和舒必利可考虑用于难治性患者的临床治疗；当锥体外系副作用引发临床问题时，这三种药物、奥氮平和阿立哌唑也可使用。阿立哌唑和舒必利具有双重治疗作用：低剂量时针对阴性症状，高剂量时针对阳性症状。
