Borison R L
Medical College of Georgia, School of Medicine, Augusta, USA.
Clin Ther. 1996 Jul-Aug;18(4):592-607; discussion 591. doi: 10.1016/s0149-2918(96)80211-6.
When treating patients with psychoses, clinicians must often consider changing their treatment from one antipsychotic agent to another. The transition may be necessary because the patient experiences serious side effects or because the existing therapy no longer controls the patient's symptoms. A principal problem in changing antipsychotic agents is the potential for withdrawal symptoms resulting from discontinuation of the existing therapy. These syndromes can manifest as reemergence or worsening of psychosis, rebound or unmasked dyskinesia, and cholinergic-rebound symptoms. Withdrawal signs and symptoms may include insomnia, nausea, vomiting, anxiety, and agitation. When switching a patient to the new antipsychotic agent risperidone, the clinician can keep withdrawal symptoms to a minimum by considering the patient's clinical history and current status. For some patients, abrupt withdrawal of the current antipsychotic may be possible. For others, the dose of the previous medication must be gradually reduced before risperidone is initiated. In many cases, the transition is best made by overlapping the existing therapy and risperidone.
在治疗精神病患者时，临床医生常常需要考虑将一种抗精神病药物换成另一种。这种转换可能是必要的，因为患者出现了严重的副作用，或者现有的治疗方法已无法控制患者的症状。更换抗精神病药物的一个主要问题是，停用现有治疗方法可能会导致戒断症状。这些综合征可能表现为精神病复发或加重、运动障碍反弹或暴露、以及胆碱能反弹症状。戒断体征和症状可能包括失眠、恶心、呕吐、焦虑和激越。当将患者换用新的抗精神病药物利培酮时，临床医生可以通过考虑患者的临床病史和当前状况，将戒断症状降至最低。对于一些患者，可以突然停用当前的抗精神病药物。对于另一些患者，在开始使用利培酮之前，必须逐渐减少先前药物的剂量。在许多情况下，最好的转换方法是让现有治疗方法和利培酮重叠使用。
