首次治疗抵抗精神分裂症患者的药物选择  

Optimal treatment strategies for the first-trial failed schizophrenia

作　　者：李旋 刘登堂[1] LI Xuan;LIU Deng-tang(Division of Psychotic Disorders,Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心精神病性障碍科,200030

出　　处：《临床精神医学杂志》2020年第3期214-216,共3页Journal of Clinical Psychiatry

基　　金：上海市精神卫生中心临床研究中心重点项目(CRC2017ZD03);国家自然科学基金项目(81871047);上海交通大学“医工交叉基金”重点项目(YG2017ZD13);上海市精神卫生中心早期精神病性障碍科(2013-YJTSZK-05)。

摘　　要：精神分裂症是一种慢性脑部疾病,以阳性症状、阴性症状和认知功能障碍为主要特征。药物治疗是精神分裂症的主要治疗方法,尽管首次治疗的有效率较高,仍有部分患者疗效欠佳,表现为治疗抵抗或发展为难治性精神分裂症。在经历第一次药物治疗失败后,这些患者的后续药物治疗选择尤其重要,本文对首次治疗抵抗精神分裂症患者探索性用药的研究进行了综述。结果显示针对首次治疗抵抗患者的前瞻性临床试验较少,仅有证据提示使用利培酮无效患者可换用奥氮平,而对于其他药物缺乏相关研究,部分学者提出氯氮平应提前使用,即首次治疗抵抗患者即开始使用氯氮平治疗,但缺乏活性药物对照研究。将来基于首发精神分裂症序贯多任务随机试验研究是个重要的临床研究方向。Schizophrenia is a severe mental illness characterized by combination of positive symptoms,negative symptoms and cognitive impairment.Antipsychotics is the main treatment for schizophrenia.Although patients with first-episode psychosis respond well to drugs,there are still some patients with poor efficacy,even becoming treatment-resistant schizophrenia or refractory schizophrenia.We review the research on switching drugs in first-trail failed schizophrenia,while the results show that few prospective studies focus on first-trail failed schizophrenia,and the only existing evidence is switching risperidone non-responders to olanzapine.Some scholars have suggested that clozapine should be considered as second-line treatment,which means clozapine should be used after patients fail a single antipsychotic trial.However,further studies like a parallel controlled trial of clozapine and other drugs are warranted to determine whether existing treatment strategies should be changed.Sequential multiple-assignment randomized trial in first-episode schizophrenia will be an important research direction in the future.

关 键 词：首次治疗抵抗 精神分裂症 抗精神病药 

分 类 号：R749.3[医药卫生—神经病学与精神病学]