安全有效的精神分裂癥急性期治療.ppt

安全有效的急性期治療,急性精神分裂癥病人出現的癥狀,Allen et al., 2001,短期治療目標,Arango & Bobes, 2004,長期治療目標,利培酮加勞拉西泮減少急性精神分裂癥病人的激越,Currier et al., 2004,p0.0001 vs. baseline at each time point for both groups Patients with agitation and active psychosis, n=147; IM, intramuscular aDerived from the Positive and Negative Syndrome Scale (PANSS),肌注奧氮平、氟派啶醇、安慰劑對激越的控制,Wright et al., 2001,n=311 p0.05 olanzapine vs. haloperidol *p0.01 haloperidol vs. placebo; *p0.001 olanzapine vs. placebo PANSS-EC, PANSS excitement component,阿立哌唑對激越的療效還不清楚,處方信息：對激越的作用類似安慰劑 病例報告使激越更嚴重，可能是由于其部分多巴胺受體激動作用所致1 其“激活”成份的使用可能與短期治療目標相沖突,1DeQuardo, 2004,治療1天后，奎硫平能減少攻擊,Ganesan et al., submitted,*p0.01 vs. baseline (Day 1) Patients with psychosis and aggression (emergency setting) n=38 OAS, Overt Aggression Scale; dose range 100-1000 mg/day,奎硫平快速起效,奎硫平快速起效,治療 一周 BPRS 總分 均值 改變,*p0.05 vs. placebo Analysis of 3 placebo-controlled studies in 620 patients with acute schizophrenia,0.0,-0.5,-1.0,-1.5,-2.0,-2.5,-3.0,-3.5,奎硫平 150-750 mg/day,安慰劑,*,改善,Small et al., 2004,奎硫平快速起效,*p0.05; *p0.01 vs. placebo Analysis of 3 placebo-controlled studies in 620 patients with acute schizophrenia,Small et al., 2004,奎硫平明顯減少敵對癥狀,Hellewell et al., 1998,*p0.05 vs. placebo a6-week data (Seroquel 600 mg/day; haloperidol 12 mg/day),奎硫平: 對精神分裂癥的廣泛療效,*p0.05; *p0.01; *p0.001 vs. placebo Meta-analysis of three 6-week, double-blind, randomised trials,Tandon, 2003,一組急性住院病人奎硫平的使用情況,Keks et al., 2004,n=137 a通過評估改善所需的時間和住院時間,治療精神分裂癥中奎硫平用藥劑量,治療天數,Smith et al., 2003; Arango & Bobes, 2004,Does not reflect current prescribing information for initiation in patients with schizophrenia; doses higher than 800 mg have been used,根據臨床經驗,1,2,3,4,200 mg,400 mg,600 mg,800 mg,600 mg 大多數病人目標劑量,750-800 mg,如果需要,奎硫平在起始快速加量給藥時耐受良好,Smith et al., 2003,Patients with schizophrenia, n=69 Initiation regimen does not reflect current prescribing information for Seroquel,到第2天，第3天或第5天，增加劑量到400 mg 不良事件的發(fā)生率相同 生命體征和實驗室檢查指標類似 每組嗜睡發(fā)生率 15% (第2天組最低),初始大劑量快速給藥不影響耐受性,奎硫平: 起始快速加量給藥研究,Pae et al., manuscript in preparation,韓國學者對比研究了思瑞康的療效和耐受性,奎硫平: 快速給藥有效且耐受性良好,*p0.001 vs baseline,Pea et al., manuscript in preparation,奎硫平: 早期明顯減少激越,*p0.05 vs normal titration p0.001 vs baseline at all time points,天數,Pae et al., manuscript in preparation,-10,-8,-6,-4,-2,0,快速給藥,正常給藥,PANSS- EC 評分的平均改變,基線,4,5,7,14,*,*,改 善,起始治療如何影響治療結果?,奎硫平治療依從性好,White, 2002,*p0.01 vs. haloperidol, risperidone, other atypical antipsychotics (AAPs) p0.01 vs. haloperidol; p0.05 vs. other AAPs *p0.05 vs. haloperidol, olanzapine and other AAPs,*,20,30,40,50,60,病人 (%),6 月,12 月,9 月,*,0,結論,在急性期，陽性癥狀的控制非常重要 早期