Ebert D
Abteilung-für Psychiatrie und Psychotherapie, Poliklinik der Klinik für Psychiatrie und Psychosomatik, Universität Freiburg/Br.
Fortschr Med. 1998 Jan 30;116(3):22-8.
Since schizophrenia is not a rare occurrence and is often chronic, the general practitioner and internist providing primary care should also be informed on new developments in treatment with neuroleptics. A major new form of treatment is provided by the so-called atypical neuroleptics which, however, in terms of their receptor specificity are not a uniform group, and have only a few properties in common. A prototype of this group is clozapine (Leponex), which has a good antipsychotic effect and virtually no action on the extrapyramidal motor system (EPS). Whether clozapine is also capable of improving the primary negative symptoms of schizophrenia (e.g. flattering of affect, reduction of drive, cognitive disorders, etc.) has not yet been ascertained. On account of the rare but possibly fatal agranulocytosis it may induce, it may be prescribed only when certain safety precautions are taken. Risperidone (Risperdal) has similar efficacy against the classical positive symptoms, with no action on the EPS (up to a medium dosage), and has no hematological effects. Other atypical neuroleptics have recently become available: quetiapine, olanzapine and sertindole. They have at least some of the advantages of clozapine but a very low risk of producing hematological effects. However, before they are widely used in the doctor's practice, further clinical experience is needed.
由于精神分裂症并非罕见且往往是慢性疾病，提供初级护理的全科医生和内科医生也应了解抗精神病药物治疗的新进展。一种主要的新治疗形式由所谓的非典型抗精神病药物提供，然而，就其受体特异性而言，它们并非一个统一的类别，仅有少数共同特性。该类药物的原型是氯氮平（利培酮），它具有良好的抗精神病作用，对锥体外系运动系统（EPS）几乎没有影响。氯氮平是否也能够改善精神分裂症的原发性阴性症状（例如情感平淡、驱力降低、认知障碍等）尚未确定。由于它可能诱发罕见但可能致命的粒细胞缺乏症，只有在采取某些安全预防措施时才可以开处方。利培酮（维思通）对典型的阳性症状有类似疗效，对EPS无影响（剂量适中时），且无血液学影响。其他非典型抗精神病药物最近已上市：喹硫平、奥氮平和舍吲哚。它们至少具有氯氮平的一些优点，但产生血液学影响的风险非常低。然而，在它们被广泛应用于医生的临床实践之前，还需要更多的临床经验。
