精神障碍药物治疗2018——精神分裂症谱系.ppt

U.S. FDA Vs CFDA: CONTRAINDICATIONS Paliperidone （帕利哌酮） How the Drug Works D2 α2 5-HT2A 5-HT7 X? Perospirone （哌罗匹隆） How the Drug Works D2 D1 α1 X？ 5-HT2A α2 5-HT1A PA Cariprazine （卡利拉嗪） 机制:D3/D2受体部分激动剂，优先结合D3 受体 适应症：精神分裂症、双相情感障碍 商品名：Vraylar 上市时间：2015年 FDA：情感平淡第一药 Brexpiprazole （布雷帕唑） 适应症：精神分裂症、抑郁发作增效剂 商品名：Rexulti 上市时间：2015年 Blocks dopamine 2 receptors,reducing positive symptoms of psychosis and stabilizing affective symptoms Blocks serotonin 2A recepors,causing enhancement of dopamine release in certain brain regions and thus reducing motor side effects and possibly improving cognitive and affective symptoms Interactions at a myriad of other neurotransmitter receptors may contribute to olanzapine’s efficacy 1 2 3 Specifically,interactions at 5-HT2c and 5-HT1A receptors may contribute to efficacy for cognitive and affective symptoms in some patients 5-HT2c antagonist actions plus serotonin reuptake blockade of fluoxetine add to the actions of olanzapine when given as Symbyax(olanzapine-fluoxetine combination) Commonly Prescribed for (bold for FDA apprved) Schizophrenia (ages 13 and older) Maintaining response in schizophrenia Bipolar maintenance Acute agitation associated with schizophrenia(intramuscular) Acute mania/mixed mania(monotherapy and adjunct to lithium or valproate)(ages 13 and older) Acute agitation associated with bipolar Ⅰmania(intramuscular) Bipolar depression [in combination with fluoxetine (Symbyax)] Commonly Prescribed for (bold for FDA apprved) Other psychotic disorders Behavioral disturbances in dementias Disorders associated with problems with impulse control Treatment-resistant depression [in combination with fluoxetine (Symbyax)] Behavioral disturbances in children and adolescents Borderline personality disorder CFDA:INDICATIONS U.S. FDA Vs CFDA:DOSING AND USE U.S. FDA: 10~20mg/day（oral or intramuscular） 6~12mg olanzapine/25~50mg fluoxetine (olanzapine-fluoxetine combi