Kim Jung-Jin, Pae Chi-Un, Han Changsu, Bahk Won-Myong, Lee Soo-Jung, Patkar Ashwin A, Masand Prakash S
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Psychopharmacol Neurosci. 2021 Nov 30;19(4):600-609. doi: 10.9758/cpn.2021.19.4.600.
The mainstay of schizophrenia treatment is pharmacological therapy using various antipsychotics including first- and second-generation antipsychotics which have different pharmacokinetic and pharmacodynamic property leading to differential presentation of adverse events (AEs) and treatment effects such as negative symptoms, cognitive symptoms and cormorbid symptoms. Major treatment guidelines suggest the use of antipsychotic monotherapy (APM) as a gold standard in the treatment of schizophrenia. However, the effects of APM is inadequate and less potent to achieve symptom remission as well as functional recovery in real practice which has been consistently reported in numerous controlled clinical trials, large practical trials, independent small studies and systematic reviews till today. Therefore anti-psychotic polypharmacy (APP) regardless of the class of antipsychotics has been also commonly utilized for many reasons in real world practice. However, APP has also crucial pitfalls including increase of total psychotics including antipsychotics, high-doses of antipsychotics used, poor compliance, drug-drug interaction and risks for developing AEs, all of which are paradoxically related to poor clinical outcomes, whereas APP has also substantial advantages in reduction of re-hospitalization, severe psychopathology and targeted control of concurrent symptoms. Given currently limited therapeutic options, it is also important to properly utilize APP in order to maximize its clinical utility and minimize its risk for better treatment outcomes for patients with schizophrenia, based on risk/benefit with full understanding of pharmacological and clinical issues on APP. The present paper intends to address intriguing and important issues in the use of APP in real world practice.
精神分裂症治疗的主要方法是药物治疗，使用包括第一代和第二代抗精神病药物在内的各种抗精神病药物，这些药物具有不同的药代动力学和药效学特性，导致不良事件（AE）的表现以及阴性症状、认知症状和共病症状等治疗效果存在差异。主要治疗指南建议使用抗精神病药物单一疗法（APM）作为精神分裂症治疗的金标准。然而，在实际临床中，APM的疗效并不理想，在实现症状缓解和功能恢复方面效果较差，这在众多对照临床试验、大型实际试验、独立小型研究和系统评价中一直都有报道。因此，在现实世界的实践中，无论抗精神病药物的类别如何，抗精神病药物联合治疗（APP）也因多种原因而被广泛使用。然而，APP也存在关键的缺陷，包括抗精神病药物总量增加、使用高剂量抗精神病药物、依从性差、药物相互作用以及发生AE的风险，所有这些都与不良临床结局存在矛盾关系，而APP在减少再住院、严重精神病理学以及针对性控制并发症状方面也具有显著优势。鉴于目前治疗选择有限，基于风险/效益，在充分了解APP的药理学和临床问题的基础上，正确使用APP以最大限度地提高其临床效用并最小化其风险，从而为精神分裂症患者带来更好的治疗效果也很重要。本文旨在探讨现实世界实践中使用APP时有趣且重要的问题。
