Miller C H, Mohr F, Umbricht D, Woerner M, Fleischhacker W W, Lieberman J A
Department of Biological Psychiatry, Innsbruck University Clinics, Austria.
J Clin Psychiatry. 1998 Feb;59(2):69-75. doi: 10.4088/jcp.v59n0205.
Acute extrapyramidal side effects (EPS) are a common phenomenon of treatment with conventional antipsychotics. Previous studies found that clozapine has little propensity to cause EPS, while risperidone produces some EPS, but at levels lower than those of conventional antipsychotics.
We compared the prevalence and severity of EPS in patients treated with clozapine, risperidone, or conventional antipsychotics for at least 3 months. Our main hypothesis was that there would be differences between the three treatment groups with regard to akathisia, measured with the Barnes Akathisia Scale, and extrapyramidal motor side effects (rigidity, rigidity factor, tremor, salivation), measured with the Simpson-Angus scale. Secondarily, we were interested in possible differences between the three groups with respect to the anticholinergic comedication and the subjective impression of the patients, measured with the van Putten scale.
We studied 106 patients (41 patients treated with clozapine, 23 patients with risperidone, and 42 patients treated with conventional antipsychotics). The sample was 57.5% male and had a mean +/- SD age of 36.6 +/- 9.3 years. The mean dose of antipsychotics calculated in chlorpromazine equivalents was 425.6 +/- 197.1 mg/day in the clozapine group, 4.7 +/- 2.1 mg/day in the risperidone group, and 476.5 +/- 476.9 mg/day in the group treated with conventional antipsychotics. The point-prevalence of akathisia was 7.3% in the clozapine group, 13% in the risperidone group, and 23.8% in the group treated with conventional antipsychotics. The point-prevalence of rigidity and cogwheeling respectively was 4.9% and 2.4% in the clozapine group, 17.4% and 17.4% in the risperidone group, and 35.7% and 26.2% in the group treated with conventional antipsychotics.
Our results indicate that risperidone is superior to conventional neuroleptics in that it causes fewer EPS. In comparison to clozapine, risperidone produces EPS levels that are intermediate between clozapine and conventional antipsychotic drugs.
急性锥体外系副作用（EPS）是使用传统抗精神病药物治疗时的常见现象。既往研究发现，氯氮平引起EPS的倾向较小，而利培酮会产生一些EPS，但程度低于传统抗精神病药物。
我们比较了使用氯氮平、利培酮或传统抗精神病药物治疗至少3个月的患者中EPS的发生率和严重程度。我们的主要假设是，使用巴恩斯静坐不能量表测量的静坐不能以及使用辛普森-安格斯量表测量的锥体外系运动副作用（强直、强直因子、震颤、流涎）在三个治疗组之间会存在差异。其次，我们感兴趣的是三组在抗胆碱能合并用药以及使用范普滕量表测量的患者主观感受方面可能存在的差异。
我们研究了106例患者（41例使用氯氮平治疗，23例使用利培酮治疗，42例使用传统抗精神病药物治疗）。样本中男性占57.5%，平均年龄为36.6±9.3岁。以氯丙嗪等效剂量计算的抗精神病药物平均剂量在氯氮平组为425.6±197.1mg/天，在利培酮组为4.7±2.1mg/天，在使用传统抗精神病药物治疗的组为476.5±476.9mg/天。静坐不能的时点患病率在氯氮平组为7.3%，在利培酮组为13%，在使用传统抗精神病药物治疗的组为23.8%。氯氮平组强直和齿轮样强直的时点患病率分别为4.9%和2.4%，利培酮组为17.4%和17.4%，使用传统抗精神病药物治疗的组为35.7%和26.2%。
我们的结果表明，利培酮在引起较少EPS方面优于传统抗精神病药物。与氯氮平相比，利培酮产生的EPS水平介于氯氮平和传统抗精神病药物之间。
