安全有效的精神分裂症急性期治疗.ppt

安全有效的急性期治疗,急性精神分裂症病人出现的症状,Allen et al., 2001,短期治疗目标,Arango & Bobes, 2004,长期治疗目标,利培酮加劳拉西泮减少急性精神分裂症病人的激越,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),肌注奥氮平、氟派啶醇、安慰剂对激越的控制,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,阿立哌唑对激越的疗效还不清楚,处方信息：对激越的作用类似安慰剂 病例报告使激越更严重，可能是由于其部分多巴胺受体激动作用所致1 其“激活”成份的使用可能与短期治疗目标相冲突,1DeQuardo, 2004,治疗1天后，奎硫平能减少攻击,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,治疗 一周 BPRS 总分 均值 改变,*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,安慰剂,*,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,奎硫平明显减少敌对症状,Hellewell et al., 1998,*p0.05 vs. placebo a6-week data (Seroquel 600 mg/day; haloperidol 12 mg/day),奎硫平: 对精神分裂症的广泛疗效,*p0.05; *p0.01; *p0.001 vs. placebo Meta-analysis of three 6-week, double-blind, randomised trials,Tandon, 2003,一组急性住院病人奎硫平的使用情况,Keks et al., 2004,n=137 a通过评估改善所需的时间和住院时间,治疗精神分裂症中奎硫平用药剂量,治疗天数,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,根据临床经验,1,2,3,4,200 mg,400 mg,600 mg,800 mg,600 mg 大多数病人目标剂量,750-800 mg,如果需要,奎硫平在起始快速加量给药时耐受良好,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，增加剂量到400 mg 不良事件的发生率相同 生命体征和实验室检查指标类似 每组嗜睡发生率 15% (第2天组最低),初始大剂量快速给药不影响耐受性,奎硫平: 起始快速加量给药研究,Pae et al., manuscript in preparation,韩国学者对比研究了思瑞康的疗效和耐受性,奎硫平: 快速给药有效且耐受性良好,*p0.001 vs baseline,Pea et al., manuscript in preparation,奎硫平: 早期明显减少激越,*p0.05 vs normal titration p0.001 vs baseline at all time points,天数,Pae et al., manuscript in preparation,-10,-8,-6,-4,-2,0,快速给药,正常给药,PANSS- EC 评分的平均改变,基线,4,5,7,14,*,*,改 善,起始治疗如何影响治疗结果?,奎硫平治疗依从性好,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,结论,在急性期，阳性症状的控制非常重要 早期