Lindström L H
Psychiatric Research Unit, University of Uppsala, Västerås Hospital, Sweden.
Acta Psychiatr Scand Suppl. 1994;380:74-6. doi: 10.1111/j.1600-0447.1994.tb05837.x.
Evaluation of neuroleptics should include not only the effects on symptoms but also social functioning and the quality of life. Akathisia, cognitive and emotional impairment (cognitive and emotional parkinsonism) are probably the most important reasons for lack of compliance with classical neuroleptics. Atypical neuroleptics such as clozapine and remoxipride offer an advantage because of little impairment of cognitive and emotional functioning. In 122 schizophrenic and schizoaffective therapy-resistant patients treated with clozapine for up to 17 years, the treatment was stopped in only 8 cases (7%) because of lack of compliance. In patients treated for more than 2 years, 40% were employed and functioned well socially. It is concluded that, in many schizophrenic patients, atypical neuroleptics should be preferred in long-term maintenance treatment because of a low incidence of extrapyramidal syndromes as well as cognitive and emotional parkinsonism. An "awakening" is often seen when changing from a classical neuroleptic to an atypical one.
对抗精神病药物的评估不仅应包括对症状的影响，还应包括对社会功能和生活质量的影响。静坐不能、认知和情感障碍（认知和情感性帕金森综合征）可能是患者不依从经典抗精神病药物治疗的最重要原因。氯氮平和瑞莫必利等非典型抗精神病药物具有优势，因为它们对认知和情感功能的损害较小。在122例接受氯氮平治疗长达17年的难治性精神分裂症和分裂情感性障碍患者中，因不依从治疗而停药的仅有8例（7%）。在接受治疗超过2年的患者中，40%有工作且社会功能良好。得出的结论是，在许多精神分裂症患者中，非典型抗精神病药物应优先用于长期维持治疗，因为锥体外系综合征以及认知和情感性帕金森综合征的发生率较低。从经典抗精神病药物换用非典型抗精神病药物时，常可见到“觉醒”现象。
