The Practice of Medicinal Chemistry
The Practice of Medicinal Chemistry
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DOI：
10.1111/j.1365-2125.2004.02080.x
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发表时间：
2004-05
影响因子：
3.4
通讯作者：
P. Jeffrey
中科院分区：
文献类型：
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作者：
P. Jeffrey
精神病治疗学起源于世纪初巴比妥类药物的出现。这些药物具有广泛的作用范围，在精神病学和神经病学治疗中占主导地位超过50年。现代精神病治疗学始于20世纪50年代，当时偶然发现了第一种抗抑郁药（丙咪嗪，异丙噻嗪）和抗精神病药（氯丙嗪）。在接下来的30年里，精神科医生处方的药物主要包括这些早期原型的后代（三环抗抑郁药，单胺氧化酶抑制剂，“经典”抗精神病药），以及后来发现的用于治疗焦虑症的苯二氮卓类药物。每类药物之间的差异相对较小，临床医生的选择主要是由个人喜好往往基于临床习惯。随着抗抑郁药（5-羟色胺或去甲肾上腺素再摄取的选择性抑制剂）和抗精神病药（“非典型”抗精神病药）的出现，情况变得更加复杂。虽然这些新药有一些相当大的临床优势，但它们也给卫生服务带来了沉重的财政负担。毫不奇怪，开处方的临床医生在“旧的和便宜的”和“新的和昂贵的”药物之间做出选择时变得非常困惑。由于苯二氮卓类药物不再是治疗焦虑相关症状的首选药物，开处方者的命运变得更加复杂。因此，真实的需要为开处方者提供一些指导。《毛兹利准则》就是对这一需要的回应。它们是由贝特勒姆药物和治疗委员会发起的，
Psychiatric therapeutics originated with the advent of the barbiturates at the beginning of the twentieth century. With their broad spectrum of action these drugs dominated psychiatric and neurological therapeutics for over 50 years. The modern era of psychiatric therapeutics started in the 1950s with the serendipitous discovery of the first antidepressants (imipramine, iproniazide) and antipsychotics (chlorpromazine). For the next 30 years drugs available for prescribing by psychiatrists included mainly descendents of these early prototypes (tricyclic antidepressants, monoamine oxidase inhibitors,‘classical’antipsychotics), together with the later discovered benzodiazepines for the treatment of anxiety disorders. The differences between individual drugs in each class were relatively minor, and the clinician’s choice was mainly guided by personal preference often based upon clinical habit. The situation has become more complex with the advent of some new classes of both antidepressants (selective inhibitors of either 5-hydroxytryptamine or noradrenaline re-uptake) and antipsychotics (‘atypical’antipsychotics). Although the new drugs have some considerable clinical advantages, they also create a significant financial burden for the Health Service. Not surprisingly, the prescribing clinician has become quite bewildered when making choices between ‘old and cheap’and ‘new and dear’drugs. The prescriber’s lot has been further complicated by the demise of the benzodiazepines as the treatment of choice for anxiety-related symptoms. Therefore, a real need has arisen to provide the prescriber with some guidelines. The Maudsley Guidelines have come about as a response to this need. They were initiated by the Drug and Therapeutics Committee of the Bethlem and