Heinrich K
Psychiatrische Klinik, Rheinische Landes- und Hochschulklinik, Universität Düsseldorf.
Fortschr Neurol Psychiatr. 1994 Feb;62(2):31-9. doi: 10.1055/s-2007-996654.
When chlorpromazine was introduced into psychiatric therapy in 1952 and thus the modern psychopharmacological era was started, the situation in psychiatry was deplorable. The psychiatric hospitals were overcrowded and obsolete, complementary institutions were widely missing. In Germany, even after introducing the neuroleptic era and the beginning of the thymoleptic epoch in 1957, no decisive improvement took place at first. As late as in the 70s successes of psychiatric reform efforts in the sense of humanization became visible, along with modern psychopharmacotherapy making an important contribution to these improvements. With the social attitude towards the mentally ill changing, this contribution became effective. In 1954 the antipsychotic efficacy of Rauwolfia alkaloids was described; in 1958 the butyrophenones, especially haloperidol, were introduced. In 1957 the antidepressive efficacy of imipramine was discovered, in the same year the psychiatric importance of monoaminoxidase inhibitors was defined. In 1949 Cade published his findings on the antimanic effect of lithium salts. As tranquilizers meprobamate (1955) and chlordiazepoxide (1960) were made available. In 1966 clozapine was introduced. Objections to psychopharmacotherapy, which were not always objective, were often raised. The biochemical research in cooperation with psychopharmacology has made progress, yet the target of clarification of the pathophysiology of the main psychoses has not been reached as yet. At present there is considerable resistance towards a further expansion of psychopharmacology, research being hampered by legal reglementation and bureaucracy. This development must be faced. Psychopharmacotherapy is not yet sufficiently effective and safe; it must be improved.
1952年氯丙嗪被引入精神科治疗,从而开启了现代精神药理学时代,当时精神科的状况令人痛心。精神病院人满为患且设施陈旧,辅助机构普遍缺失。在德国,即使在引入抗精神病药物时代以及1957年开始心境稳定剂时代之后,起初也没有取得决定性的改善。直到70年代,人性化意义上的精神科改革努力才初见成效,现代精神药物治疗对这些改善做出了重要贡献。随着社会对精神疾病患者态度的转变,这种贡献开始发挥作用。1954年描述了萝芙木生物碱的抗精神病作用;1958年引入了丁酰苯类药物,尤其是氟哌啶醇。1957年发现了丙咪嗪的抗抑郁作用,同年确定了单胺氧化酶抑制剂的精神科重要性。1949年凯德发表了关于锂盐抗躁狂作用的研究结果。作为镇静剂,甲丙氨酯(1955年)和氯氮卓(1960年)开始应用。1966年引入了氯氮平。人们常常提出对精神药物治疗的反对意见,而这些意见并不总是客观的。与精神药理学合作的生化研究取得了进展,但尚未达到阐明主要精神病病理生理学的目标。目前,对于精神药理学的进一步扩展存在相当大的阻力,研究受到法律法规和官僚作风的阻碍。必须面对这一发展态势。精神药物治疗尚未充分有效和安全;必须加以改进。