Typical and atypical antipsychotics -: The misleading dichotomy
Typical and atypical antipsychotics -: The misleading dichotomy
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DOI：
10.1159/000135641
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发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Klein, Helmfried E.
中科院分区：
文献类型：
--
作者：
Fischer-Barnicol, David;Lanquillon, Stefan;Klein, Helmfried E.
目的：（1）研究在自然治疗条件下，与不同抗精神病药处方相关的锥体外系运动副作用（EPS）风险;（2）基于EPS发生率，检验术语“典型”和“非典型”的基本原理。设计：在联邦巴伐利亚州的横断面研究。地点：巴伐利亚州的20家精神病医院。研究对象：6,061名住院患者，年龄18-65岁，患有精神障碍。主要结果测量：与抗胆碱能药物比哌立登的联合用药被用作EPS的指标。计算EPS的比值比和需要伤害的人数[与对照治疗（氯氮平）相比，需要接受治疗以获得多一个具有不良结局（即EPS）的病例的患者人数]，以获得15种不同抗精神病药物的风险估计。结果：“典型”和“非典型”抗精神病药物组的EPS率并不均匀，各组内差异很大。EPS的频率也不允许在各组之间进行明确区分。这有两个原因：首先，EPS率在整个研究药物范围内持续上升，因此排除了临界值的定义;第二，两组之间有相当大的重叠，因为各种“药物”的EPS率（例如氨磺必利、利培酮和佐替平）与一些“典型”物质没有差异（例如氟奋乃静），而一种“典型的”抗精神病药（哌嗪）甚至比大多数“药物”具有更低的EPS风险。结论：诱导EPS的几率在“典型”和“非典型”抗精神病药物之间没有区别，因为EPS率在两个类别中连续上升。我们建议放弃将抗精神病药物分类为“典型”和“非典型”，而是使用风险估计，如EPS所需的伤害数量，以帮助抗精神病药物治疗的获益/风险考虑。版权所有（c）2008 S. Karger AG，巴塞尔。
Objectives: (1) To investigate the risk of extrapyramidal motor side effects (EPS) associated with the prescription of different antipsychotics under naturalistic treatment conditions; (2) to test the rationale of the terms 'typical' and 'atypical' based on EPS rates. Design: Cross-sectional study in the federal state of Bavaria. Setting: 20 psychiatric hospitals in Bavaria. Participants: 6,061 inpatients, aged 18-65 years, with psychotic disorders. Main Outcome Measures: Co-medication with the anticholinergic biperiden was used as an index of EPS. Odds ratios for EPS and numbers needed to harm [number of patients who would need to be treated to obtain one more case with an adverse outcome (i.e. EPS) as compared with the control treatment (clozapine)] were calculated to obtain risk estimates for 15 different antipsychotics. Results: Groups of 'typical' and 'atypical' antipsychotics were not homogeneous in their EPS rates, and showed wide variation within each group. Nor did the frequency of EPS allow a clear distinction between the groups. There were 2 reasons for this: first, EPS rates rose continuously over the whole spectrum of drugs under study, and therefore precluded the definition of a cut-off score; second, there was considerable overlap between the 2 groups as EPS rates of various 'atypicals' (e.g. amisulpride, risperidone and zotepine) did not differ from some 'typical' substances (e.g. fluphenazine), while one 'typical' antipsychotic (perazine) even had a lower EPS risk than most 'atypicals'. Conclusions: The odds of inducing EPS are not distinguishable between 'typical' and 'atypical' antipsychotics as EPS rates rise on a continuous scale throughout both classes. We propose dropping the categorization of antipsychotics as 'typical' and 'atypical' and instead using risk estimates like number needed to harm for EPS to help in benefit/risk considerations for antipsychotic treatment. Copyright (c) 2008 S. Karger AG, Basel.