课件：精神分裂症药物治疗进展分析.ppt

THANK YOU SUCCESS * * 可编辑 There are two major obstacles to continuous improvement in patients with schizophrenia and other psychiatric disorders who are prescribed pharmacotherapy. First, patients may receive medication but not take it as prescribed, which will reduce the effectiveness of treatment and contribute to residual symptoms after relapse, clinical worsening, deterioration in social functioning, and ultimately relapse. Because irregular medication use increases the risk of side effects and decreases efficacy, it may lead the physician to prescribe additional medications to treat side effects and/or increase the dose to boost efficacy. In both cases, the total medication burden is increased. Second, the medication itself may be less effective than an alternative treatment. Risperdal CONSTA is the latest advance in antipsychotic treatment, combining improved pharmacotherapy with a long-acting delivery system that removes the challenge of compliance with daily medication. The efficacy of Risperdal CONSTA has been evaluated in several clinical trials, including a long-term trial that shows its superior clinical profile and favorable impact on compliance compared with prior treatment in clinically stable patients. 具有抗胆碱作用的药物锥体外系副作用较轻 (1Casey D, J Clin Psychiatry 1996;57:40-5, 2Hagg S et al, Lancet 2000;355:1155-6, 3Wirshing DA et al, Biol Psychiatry 1998;44:778-83) 抗精神病药：急性治疗 控制症状一般至少需要 6-8周 急性期最大剂量不一定是最佳有效剂量 在足量情况下，最短的治疗观察需4-6周 如果疗效不佳，换用不同化学结构的药物 初次使用出现的不良反应与将来疗效差及依从性差有关 不良体验包括：快感缺失、过度镇静、急性肌张力障碍 早期出现严重不良反应时，不足4周可换药 抗精神病药：巩固治疗 巩固治疗(继续治疗)用于急性症状控制后恢复期 采用原有效剂量继续治疗 复发多在急性期治疗后的6个月左右, 巩固治疗时间应尽量跨过这一阶段 以往资料多提出6-8周或1-2月 APA (1997, 2004) 至少6个月 国内治疗指南建议至少3-6个月 复发高峰 有关6个月随访的汇萃分析表明 药物维持治疗者20%复发 安慰剂维持治疗者50% 4-6月内复发 药物维持6个月可以减少复发2.5-5倍 抗精神病药：维持治疗 维持治疗用于疾病稳定期，也可包括恢复期 维持剂量通常比有效剂量低 精神分裂症的5年内复发率在75%以上 维持治疗时间尚无公认标准 John Kane主张：(2001)首发病人5年，复发病人终身 (2005)分裂症患者应无限期治疗 Csernansky介绍，(2002)分裂症患者应终身治疗 药物维持治疗时间 Ben等（1981）提出，维持治疗的时间因人而异 急性发病、症状持续时间短暂