Amon Jin Shi, Johnson Sarah B, El-Mallakh Rif S
Drs. Amon, MD, Johnson, MD, El-Mallakh, MD, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky.
Psychopharmacol Bull. 2017 Jan 26;47(1):27-32.
It has been previously purported that higher relative affinity to the dopamine D4 receptor compared to D2 (i.e., D4/D2 affinity ratio > 1) may underlie unique antiaggression potency. Asenapine is a newer antipsychotic that also has D4/D2 affinity ratio > 1. It has demonstrated efficacy in reducing acute agitation in a placebo-controlled study. We performed a prospective naturalistic, pilot, proof of concept study on an inpatient psychiatric unit. Among patients with aggression at time of admission (≥ 12 on Refined Aggression Questionnaire [RAQ], or ≥ 2 on Modified Overt Aggression Scale [MOAS]), asenapine treatment was associated with a significant reduction in total aggression as measured by the MOAS (-14.7 ± 11.59 vs. -5.4 ± 10.12, P = 0.045), and particularly physical aggression (-8.0 ± 5.06 vs. -0.78 ± 2.40, P < 0.0001) compared to treatment that did not include asenapine. These data suggest that asenapine may be useful in the targeted treatment of aggression, and provide some support for the D4/D2 affinity ratio hypothesis.
先前有观点认为，与多巴胺D2受体相比，对多巴胺D4受体具有更高的相对亲和力（即D4/D2亲和力比值>1）可能是独特的抗攻击效力的基础。阿立哌唑是一种新型抗精神病药物，其D4/D2亲和力比值也>1。在一项安慰剂对照研究中，它已证明在减轻急性激越方面有效。我们在一个住院精神科病房进行了一项前瞻性自然主义的概念验证性先导研究。在入院时具有攻击性的患者（在改良攻击问卷[RAQ]上≥12分，或在改良明显攻击量表[MOAS]上≥2分）中，与未使用阿立哌唑的治疗相比，阿立哌唑治疗使MOAS测量的总攻击行为显著减少（-14.7±11.59对-5.4±10.12，P=0.045），尤其是身体攻击行为（-8.0±5.06对-0.78±2.40，P<0.0001）。这些数据表明阿立哌唑可能在针对性治疗攻击行为方面有用，并为D4/D2亲和力比值假说提供了一些支持。
