Gosselin O, Di Scala G, Ribeyre J M, Kahn J P
Service de Psychologie Médicale, Hôpital Jeanne D'Arc, CHU de Nancy.
Encephale. 1996 Dec;22 Spec No 6:3-6.
The synthesis of new compounds called atypical neuroleptics such as amisulpride, clozapine, risperidone and now olanzapine has roused interest in the psychopharmacology of atypical antipsychotics. Since the synthesis of chlorpromazine in the early 1950s, subsequent therapeutic research has had two main goals: to define the mechanism of action of atypical neuroleptics and to search new compounds with both clinical efficacy and fewer side effects. The first one has widely been achieved, as it is clear that classical neuroleptics exert their effects by blockade of dopamine D2 receptors located in the ventral striatum. As a matter of fact, non specific blockade of dopaminergic receptors in the dorsal striatum also predicts extrapyramidal side effects. Moreover, classical neuroleptics have poor effects on negative and cognitive symptoms. That is why the search for new compounds has focused on two main goals: first, understanding the interactions of the neurotransmitters involved by the new drugs, second, characterizing their brain site of action. Achieving these two goals might enable us to precise the notion of atypicity as well as the classification of these new drugs.
新型化合物(如氨磺必利、氯氮平、利培酮以及现在的奥氮平)这类非典型抗精神病药物的合成,引发了人们对非典型抗精神病药物精神药理学的兴趣。自20世纪50年代初氯丙嗪合成以来,后续的治疗研究有两个主要目标:明确非典型抗精神病药物的作用机制,以及寻找具有临床疗效且副作用更少的新化合物。第一个目标已广泛实现,因为很明显经典抗精神病药物通过阻断位于腹侧纹状体的多巴胺D2受体发挥作用。事实上,背侧纹状体中多巴胺能受体的非特异性阻断也预示着锥体外系副作用。此外,经典抗精神病药物对阴性和认知症状疗效不佳。这就是为什么寻找新化合物聚焦于两个主要目标:其一,了解新药所涉及的神经递质之间的相互作用;其二,确定它们在大脑中的作用部位。实现这两个目标或许能让我们明确非典型性的概念以及这些新药的分类。