Lieberman J A
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27514-7160, USA.
J Clin Psychiatry. 1996;57 Suppl 11:68-71.
Clozapine represented the first significant advance in the pharmacotherapy of schizophrenia since the introduction of conventional antipsychotic drugs in the 1950's. Despite its superior efficacy and potential to reduce substantially the morbidity of schizophrenia and improve the outcomes, of patients, clozapine has not been used on a widespread basis or as a first-line treatment due to its potential for agranulocytosis. With the introduction of risperidone and the imminent prospect of other atypical antipsychotic drugs (olanzapine, sertindole, quetiapine, ziprasidone), clinicians may be able to improve dramatically the methods and manner in which they treat schizophrenia and related psychotic disorders. If we accept the premise that atypical antipsychotic drug provide superior efficacy, reduced side effects, and the prospect of better compliance, their greatest impact may be when used in patients at the beginning of their illness. The following article provides a rationale and hypothesis for the use of atypical antipsychotic drugs as a first-line treatment of schizophrenia.
自20世纪50年代传统抗精神病药物问世以来，氯氮平是精神分裂症药物治疗方面的首个重大进展。尽管氯氮平疗效卓越，有大幅降低精神分裂症发病率并改善患者预后的潜力，但因其有引发粒细胞缺乏症的风险，尚未得到广泛应用，也未被用作一线治疗药物。随着利培酮的推出以及其他非典型抗精神病药物（奥氮平、舍吲哚、喹硫平、齐拉西酮）即将问世，临床医生或许能够显著改进治疗精神分裂症及相关精神障碍的方法和方式。如果我们认可非典型抗精神病药物疗效更佳、副作用更少且有望提高依从性这一前提，那么它们最大的影响可能体现在疾病初期就开始使用的患者身上。以下文章为将非典型抗精神病药物用作精神分裂症一线治疗提供了理论依据和假设。
