Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, 303 East Chicago Ave, Ward Building 7-101, Chicago, Il 60611, United States.
CNS Neurol Disord Drug Targets. 2017;16(8):900-906. doi: 10.2174/1871527316666170728165355.
This article are to describe current trends in the treatment of schizophrenia and the most interesting new approaches to optimizing outcome and fostering the development of new schizophrenia treatments.
Increasing utilization of diverse types of atypical antipsychotic drugs (AAPDs), e.g. clozapine- type serotonin (5-HT)2A and weak dopamine (DA) D2 antagonist, amisulpride, a D2/D3/5-HT7 antagonist, and cariprazine, a D3 partial agonist with additional neurotransmitter targets, is occurring as their advantages in efficacy, especially for cognitive impairment and mood symptoms, and side effects are becoming appreciated. Typical APDs, e.g. haloperidol, are diminishing in favor because of their EPS, especially, tardive dyskinesia (T D) and appreciation that reducing D2 receptor stimulation is not the only means to treat psychosis. Some of the mechanisms inherent in various AAPDs, e.g. 5-HT2A inverse agonism, and D3 receptor partial agonism, are now recognized as effective treatments for psychosis. A new focus on treating the cognitive impairment associated with schizophrenia (CIAS) has emerged via mechanisms such as stimulation of acetyldraline receptor with muscarinic and nicotinic receptor agonists, but demonstrating their efficacy in trials is proving elusive. Pharmacogenetic strategies which may lead to personalized treatment of schizophrenia are emerging but have not yet succeeded in being widely reimbursable. Transcranial stimulation and cognitive enhancement therapy are more common but more evidence for their efficacy is needed.
The heterogeneity of the pathophysiology of the various domains of schizophrenia requires a diversity of treatments that are best met by the expert use of AAPDs at the current time. Pharmacogenetic efforts are consistent with new evidence that multiple genes are involved in the risk for schizophrenia and the effectiveness of AAPDs.
本文旨在描述目前治疗精神分裂症的趋势，以及优化疗效和促进新的精神分裂症治疗方法发展的最有趣的新方法。
越来越多地使用多种类型的非典型抗精神病药物（AAPD），例如氯氮平型 5-HT2A 和弱多巴胺（DA）D2 拮抗剂、阿米舒必利（一种 D2/D3/5-HT7 拮抗剂）和卡利拉嗪（一种具有额外神经递质靶点的 D3 部分激动剂），因为它们在疗效方面的优势，特别是在认知障碍和情绪症状方面，以及副作用的优势，正在得到认可。典型的 APD，例如氟哌啶醇，由于其 EPS，特别是迟发性运动障碍（TD），以及减少 D2 受体刺激并不是治疗精神病的唯一手段，因此正在减少。各种 AAPD 固有的一些机制，例如 5-HT2A 反向激动剂和 D3 受体部分激动剂，现在被认为是治疗精神病的有效方法。通过刺激乙酰多巴胺受体与毒蕈碱和烟碱受体激动剂等机制，新的关注点出现了，即治疗与精神分裂症相关的认知障碍（CIAS），但在试验中证明其疗效却很困难。可能导致精神分裂症个体化治疗的药物遗传学策略正在出现，但尚未成功获得广泛的报销。经颅刺激和认知增强疗法更为常见，但需要更多的证据证明其疗效。
精神分裂症的各种领域的病理生理学的异质性需要多种治疗方法，目前最好的方法是使用 AAPD 进行专家治疗。药物遗传学研究与新的证据一致，即多个基因参与精神分裂症的风险和 AAPD 的有效性。
