Casey D E
Psychiatry Service (116A), VA Medical Center, Portland, OR 97207, USA.
J Clin Psychiatry. 1996;57 Suppl 11:40-5; discussion 46-52.
Although neuroleptic drugs have become the mainstay of treating acute and chronic psychosis, they are substantially limited by troublesome side effects. The traditional neuroleptic drugs have a wide array of central nervous system and peripheral system side effects that often lead to problems in management or patient noncompliance. Of particular difficulty are the extrapyramidal symptoms and tardive dyskinesia. However, other side effects of seizures, sedation, neuroleptic malignant syndrome and cardiovascular, hematologic, endocrinological, and weight gain problems remain as clinical management challenges posed by existing antipsychotic drug therapy. Considerable progress has been made in improving the motor side effect profile with the advent of clozapine and risperidone. However, each of these drugs has its own dose-limiting side effect profile. Two new drugs, olanzapine and sertindole, are now added to the pharmacopeia for treating psychosis. They further improve the benefit/ risk ratio because they have even fewer EPS and other side effects. Overall, these new antipsychotic agents greatly improve the treatment of psychosis by reducing drug-induced morbidity and improving the quality of life for patients.
尽管抗精神病药物已成为治疗急慢性精神病的主要手段,但它们受到诸多令人烦恼的副作用的严重限制。传统抗精神病药物有一系列广泛的中枢神经系统和外周系统副作用,常常导致治疗管理方面的问题或患者不依从。特别棘手的是锥体外系症状和迟发性运动障碍。然而,癫痫发作、镇静作用、抗精神病药物恶性综合征以及心血管、血液、内分泌和体重增加等问题作为现有抗精神病药物治疗带来的临床管理挑战依然存在。随着氯氮平和利培酮的出现,在改善运动副作用方面已取得了相当大的进展。然而,这些药物中的每一种都有其自身的剂量限制性副作用。两种新药奥氮平和舍吲哚现已被添加到治疗精神病的药典中。它们进一步改善了效益/风险比,因为它们的锥体外系反应和其他副作用更少。总体而言,这些新型抗精神病药物通过降低药物引起的发病率并改善患者生活质量,极大地改进了精神病的治疗。