Wang Chuanyue
Beijing Anding Hospital, Beijing, China.
Shanghai Arch Psychiatry. 2015 Dec 25;27(6):368-70. doi: 10.11919/j.issn.1002-0829.215086.
Antipsychotic polypharmacy in the treatment of schizophrenia is more common in China and other Asian countries than in Western countries. The reasons for this are unclear, but it may be related to an unsubstantiated belief among clinicians that multiple medications are more likely to achieve the desired clinical outcome. Antipsychotic medications are the mainstay of treatment for individuals with schizophrenia, but the use of antipsychotic polypharmacy and of high dosages of antipsychotic medication are associated with substantially increased risks without conferring improved clinical outcomes. It is generally accepted that high dosages of antipsychotic medications and the simultaneous use of multiple antipsychotics are associated with an increased prevalence, duration, and severity of adverse drug effects. More recent evidence also suggests that antipsychotic polypharmacy and the associated high overall dosage of antipsychotic medication lead to excessive striatal D2 receptor occupation (resulting in tolerance and drug withdrawal problems) and exacerbation of the impaired synaptic plasticity seen in schizophrenia (magnifying the cognitive impairment associated with the condition). Clinicians need to apply the 'less is more' principle in the psychopharmacological treatment of schizophrenia.
在中国和其他亚洲国家，抗精神病药物联合治疗精神分裂症比西方国家更为常见。其原因尚不清楚，但这可能与临床医生中一种未经证实的观念有关，即多种药物更有可能实现预期的临床疗效。抗精神病药物是精神分裂症患者治疗的主要手段，但使用抗精神病药物联合治疗和高剂量抗精神病药物会大幅增加风险，却不会带来更好的临床疗效。人们普遍认为，高剂量抗精神病药物以及同时使用多种抗精神病药物会增加药物不良反应的发生率、持续时间和严重程度。最新证据还表明，抗精神病药物联合治疗以及相关的高剂量抗精神病药物总体用量会导致纹状体D2受体过度占据（导致耐受性和药物戒断问题），并加剧精神分裂症中出现的突触可塑性受损（放大与该疾病相关的认知障碍）。临床医生在精神分裂症的心理药物治疗中需要应用“少即是多”的原则。
