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在非典型 2 代抗精神病药物(AAPs)下诱导精神分裂症患者出现强迫症状(OCS):综述与假说。

Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses.

机构信息

Hôpital Universitaire Paul Brousse, Service de Psychiatrie et Addictologie, 12 avenue Paul Vaillant-Couturier, 94800 Villejuif, France; UnitéINSERM 1178, Hôpital Universitaire Paul Brousse, France.

Hôpital Sainte-Anne, Service Hopitalo-Universitaire, 1, rue Cabanis, 75014 Paris, France.

出版信息

Psychiatry Res. 2016 Dec 30;246:119-128. doi: 10.1016/j.psychres.2016.09.031. Epub 2016 Sep 21.

Abstract

The prevalence of OCS and OCD is higher in schizophrenic patients than in the general population. These disorders are sometimes induced by AAPs. There is higher frequency of OCS and greater severity in patients treated with antipsychotics with predominant anti-serotoninergic profiles opposed to those with predominant dopaminergic blockade. Induced OCS may be due to complex neuromodulation involving many serotonin, dopamine and glutamate receptors and several subtypes. Concerning connectivity, AAPs differentially influence the BOLD signal, depending on the intensity of D2 receptor blockade. The OFC could play a significant role, on account of its involvement in inhibitory control. There is a paradox: AAPs are efficient as augmentation to SSRI in treatment resistant OCD, some of them such as risperidone or aripiprazole have favourable effects in schizoptypic OCD, but AAPs cause induced OCS in schizophrenic patients. When prescribing AAPs, we should inform patients about this potential side effect and assess systematically OCS with Y-BOCS assessment after 1 month of treatment. Afterwards there are different strategies: Aripiprazole in combination can reduce OCS induced by clozapine, SSRI are slightly effective and CBT shows a few encouraging results. OCS are sometimes dose-dependent, so we also recommend prescribing the minimum effective dose and gradual introduction.

摘要

精神分裂症患者中强迫症状和强迫症的患病率高于普通人群。这些障碍有时是由抗精神病药物引起的。与具有主要多巴胺阻断作用的抗精神病药物相比,具有主要抗血清素能作用的抗精神病药物治疗的患者中强迫症状的频率更高,严重程度更大。诱导的强迫症状可能是由于涉及许多血清素、多巴胺和谷氨酸受体以及几种亚型的复杂神经调节。关于连通性,抗精神病药物根据 D2 受体阻断的强度,对 BOLD 信号有不同的影响。OFC 可能起重要作用,因为它参与抑制控制。存在一个悖论:抗精神病药物在治疗抵抗性强迫症中作为增效剂是有效的,其中一些,如利培酮或阿立哌唑,在精神分裂型强迫症中有良好的效果,但抗精神病药物会在精神分裂症患者中引起诱导的强迫症状。在开处方时,我们应该告知患者这种潜在的副作用,并在治疗 1 个月后用 Y-BOCS 评估系统地评估强迫症状。之后有不同的策略:阿立哌唑联合使用可以减少氯氮平引起的强迫症状,SSRIs 略有效果,CBT 显示出一些令人鼓舞的结果。强迫症状有时与剂量有关,因此我们还建议开最小有效剂量,并逐步引入。

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