Jacobsen F M
Transcultural Mental Health Institute, Washington, DC 20036-6043, USA.
J Clin Psychiatry. 1995 Sep;56(9):423-9.
Risperidone is a new-generation atypical antipsychotic agent with potent dopaminergic and serotonergic antagonist activity. Compared with traditional dopamine-blocking neuroleptics, risperidone is more effective in treating negative symptoms of schizophrenia and may be less likely to cause extrapyramidal symptoms or tardive dyskinesia. Although risperidone is marketed for the treatment of schizophrenia, its novel psychopharmacologic effects and potentially mild side effect profile suggest the possibility of other therapeutic applications. An open prospective study was undertaken to determine whether risperidone might diminish psychosis, severe agitation, or rapid cycling in patients having acute and chronic primary affective illnesses (bipolar and major depressive disorder) and to document response characteristics and side effects. Additionally, a small number of patients with refractory obsessive-compulsive disorder (OCD) without comorbid tic or delusional disorders were given open trials of risperidone added to their medication.
Outpatients who fulfilled DSM-IV criteria for bipolar I, bipolar II, or major depressive disorder and suffered from psychosis or agitation associated with their illness (N = 20) and those who had treatment-refractory DSM-IV OCD (N = 5) were started on open trials of risperidone at daily doses of 1 to 1.5 mg. Doses were adjusted upwards to a maximum of 6 mg depending on clinical response.
Seventeen (85%) of 20 patients (13 bipolar, 4 major depressive disorder) showed complete or partial improvement after treatment with risperidone doses ranging from 1 to 6 mg/day (mean = 3.5 mg). Beneficial effects included decreases in agitation, psychosis, sleep disturbance, and rapid cycling. Four patients (20%) discontinued risperidone because of intolerable side effects. Five patients with refractory OCD also showed significant symptomatic improvement after the addition of risperidone.
The findings suggest that (1) risperidone may be useful in the acute/p.r.n. and chronic treatment of psychosis, agitation, and cycling accompanying affective illness, and (2) risperidone may be useful in augmenting pharmacologic response in OCD.
利培酮是一种新一代非典型抗精神病药物，具有强大的多巴胺能和5-羟色胺能拮抗活性。与传统的多巴胺阻断性抗精神病药物相比，利培酮在治疗精神分裂症的阴性症状方面更有效，并且引起锥体外系症状或迟发性运动障碍的可能性较小。尽管利培酮已上市用于治疗精神分裂症，但其新颖的精神药理作用和潜在的轻微副作用表明它可能有其他治疗用途。开展了一项开放性前瞻性研究，以确定利培酮是否可以减轻患有急性和慢性原发性情感疾病（双相情感障碍和重度抑郁症）患者的精神病症状、严重激越或快速循环发作，并记录其反应特征和副作用。此外，对少数没有共患抽动或妄想性障碍的难治性强迫症（OCD）患者进行了开放试验，在其原有药物治疗基础上加用利培酮。
符合双相I型、双相II型或重度抑郁症的DSM-IV标准且患有与其疾病相关的精神病或激越症状的门诊患者（N = 20），以及患有难治性DSM-IV强迫症的患者（N = 5）开始接受利培酮的开放试验，每日剂量为1至1.5毫克。根据临床反应将剂量向上调整至最大6毫克。
20例患者（13例双相情感障碍，4例重度抑郁症）中的17例（85%）在接受1至6毫克/天（平均 = 3.5毫克）的利培酮治疗后显示出完全或部分改善。有益效果包括激越、精神病症状、睡眠障碍和快速循环发作减少。4例患者（20%）因无法耐受副作用而停用利培酮。5例难治性强迫症患者在加用利培酮后也显示出明显的症状改善。
研究结果表明：（1）利培酮可能对情感疾病伴发的精神病、激越症状和循环发作的急性/必要时及慢性治疗有用，（2）利培酮可能有助于增强强迫症的药物治疗反应。
