Evidence for onset of antipsychotic effects within the first 24 hours of treatment
Evidence for onset of antipsychotic effects within the first 24 hours of treatment
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DOI：
10.1176/appi.ajp.162.5.939
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发表时间：
2005-05-01
影响因子：
17.7
通讯作者：
Jones, B
中科院分区：
文献类型：
--
作者：
Kapur, S;Arenovich, T;Jones, B
目的：人们普遍认为，抗精神病药物的作用具有延迟性，任何早期效应都代表非特异性行为效应。最近的研究表明，抗精神病药物的作用在第一周内开始。作者测试的假设，精神病改善的第一个24小时内的抗精神病药物treatment.Method：在这个多中心，双盲，安慰剂对照研究，311例诊断为精神分裂症谱系障碍和急性加重患者被随机分配到接受10毫克肌内注射。奥氮平，7.5 mg i.m.或者肌肉注射安慰剂。受试者在基线，2小时，24 hours.Results：奥氮平和氟哌啶醇组表现出更大的整体症状的决议比安慰剂组，奥氮平组，这种效果是明显的，在2小时。一项因素分析显示，两种药物在最初24小时内都明显表现出精神病的独立变化（包括概念混乱、幻觉行为、不寻常的思想内容）。这种改善核心精神病是不介导单向的非特异性行为的影响或其他psychopathology.Conclusions的变化：这些数据表明，抗精神病药物的作用是早期的发病和这种行动的幅度随着时间的推移而增长。这一临床现实对一些关于抗精神病药物作用机制的流行假设提出了质疑，并表明抗精神病药物的作用可能比最初认为的更接近于多巴胺传递的阻断。
Objective: It is widely held that there is a delayed onset of antipsychotic action and that any early effects represent nonspecific behavioral effects. Recent research has shown that antipsychotic action begins within the first week. The authors tested the hypothesis that psychosis improves within the first 24 hours of antipsychotic treatment.Method: In this multicenter, double-blind, placebo-controlled study, 311 patients with a diagnosis of schizophrenia spectrum disorder and an acute exacerbation were randomly assigned to receive 10 mg i.m. of olanzapine, 7.5 mg i.m. of haloperidol, or intramuscular placebo. Subjects were rated with structured rating scales ( Positive and Negative Syndrome Scale and Clinical Global Impression) at baseline, 2 hours, and 24 hours.Results: The olanzapine and haloperidol groups showed greater resolution of overall symptoms than the placebo group; for the olanzapine group, this effect was evident at 2 hours. A factor analysis showed that an independent change in psychosis ( which included conceptual disorganization, hallucinatory behavior, unusual thought content) was evident within the first 24 hours for both drugs. This improvement in core psychosis was not mediated unidirectionally by changes in nonspecific behavioral effects or other psychopathology.Conclusions: These data suggest that the onset of antipsychotic action is early and that the magnitude of this action grows with time. This clinical reality calls into question some prevailing hypotheses regarding the mechanism of action of antipsychotics and suggests that antipsychotic action may be more proximally related to the blockade of dopamine transmission than was originally thought.