Lange Bettina, Mueller Juliane K, Leweke F Markus, Bumb J Malte
a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany.
b Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health , Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany.
Expert Opin Pharmacother. 2017 Mar;18(4):351-362. doi: 10.1080/14656566.2017.1288722. Epub 2017 Feb 13.
The effectiveness, effective dosages and side effect profiles of antipsychotic medication differ significantly between the sexes. Areas covered: We present a systematic review of gender-differences in the treatment of psychosis focusing on randomized, controlled trials and meta-analyses. Expert opinion: Despite many years of research, the database on gender-differences affecting the pharmacotherapeutic approach to treating psychosis is insufficient. Currently, the US National Institute of Health encouraged the enrolment of female participants in federally supported phase III clinical trials to increase the data available of female patients. Emerging evidence points to a superior antipsychotic response in women, with men requiring higher dosages. In general, women metabolize drugs differently, resulting in side effects occuring more frequently when compared to men. In any case, women require electrocardiograms or bone density scans as well as diabetes and cardiovascular workups when treated with antipsychotics. Dose adjustments during the menstrual cycle (e.g. to raise antipsychotic doses premenstrually) should be considered. First-generation antipsychotics, drugs that are known to prolong QTc interval and increase prolactin levels should be avoided in postmenopausal female patients. Furthermore, the effects of antipsychotics during pregnancy and breastfeeding have been investigated insufficiently, and more research is urgently needed.
抗精神病药物的疗效、有效剂量和副作用在性别之间存在显著差异。涵盖领域：我们对精神病治疗中的性别差异进行了系统综述，重点关注随机对照试验和荟萃分析。专家观点：尽管经过多年研究，但影响精神病药物治疗方法的性别差异数据库仍然不足。目前，美国国立卫生研究院鼓励在联邦支持的III期临床试验中纳入女性参与者，以增加女性患者的可用数据。新出现的证据表明女性对抗精神病药物的反应更好，而男性需要更高的剂量。一般来说，女性对药物的代谢方式不同，与男性相比，副作用出现得更频繁。无论如何，女性在使用抗精神病药物治疗时需要进行心电图或骨密度扫描以及糖尿病和心血管检查。应考虑在月经周期进行剂量调整（例如在经前提高抗精神病药物剂量）。绝经后女性患者应避免使用已知会延长QTc间期并增加催乳素水平的第一代抗精神病药物。此外，抗精神病药物在妊娠和哺乳期的影响尚未得到充分研究，迫切需要更多研究。
