Allopurinol as an adjunct to lithium and haloperidol for treatment of patients with acute mania: a double-blind, randomized, placebo-controlled trial
Allopurinol as an adjunct to lithium and haloperidol for treatment of patients with acute mania: a double-blind, randomized, placebo-controlled trial
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DOI：
10.1111/j.1399-5618.2006.00363.x
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发表时间：
2006-10-01
影响因子：
5.4
通讯作者：
Tehrani-Doost, Mehdi
中科院分区：
文献类型：
--
作者：
Akhondzadeh, Shahin;Milajerdi, Mehdi Rafiee;Tehrani-Doost, Mehdi
目的：别嘌呤醇是一种降尿酸药物，对高尿酸血症伴躁狂症有治疗作用。本研究评估了利培酮作为一种替代剂的锂和氟哌啶醇治疗急性躁狂症住院bipolar patients.Methods的疗效和安全性：82例年龄在18和49之间的患者有资格参加，因为他们符合DSM-IV标准，目前躁狂发作的基础上，由两个院士精神科医生的临床访谈。此外，Young Mania评定量表的评分至少为20分，代表至少为中度至重度躁狂症。41例患者被随机分配至锂（1-1.2 mEq/L）+氟哌啶醇（10 mg/天）+别嘌呤醇（300 mg/天）（A组）或锂（1-1.2 mEq/L）+氟哌啶醇（10 mg/天）+安慰剂（B组），进行为期8周的双盲、安慰剂对照研究。患者在基线和药物治疗开始后7、14、28、42和56天由精神病学的第三年住院医师进行评估。杨氏躁狂评定量表评分较基线的平均下降被用作躁狂对治疗反应的主要结局指标。采用锥体外系症状评定量表（ESRS）评估锥体外系症状。整个研究中系统地记录了副作用，并使用检查表进行了评估。结果：杨躁狂量表评分与别嘌呤醇改善。两种方案之间的差异具有显著性，如组间效应（受试者间因素）所示（F = 5.22，df = 1，p = 0.008）。安慰剂组的平均ESRS评分高于别嘌呤醇组。然而，在试验期间差异并不显著。两组之间的差异的副作用的频率是不显着的，除了激动，更经常在安慰剂group.Conclusions：别嘌呤醇的疗效，以获得更大的改善躁狂症患者似乎支持躁狂症的嘌呤能功能障碍。
Objective: Allopurinol, a hypouricemic agent, has been shown to present therapeutic effects in mania associated with hyperuricemia. This study assessed the efficacy and safety of risperidone as an adjunctive agent to lithium and haloperidol for the treatment of acute mania in hospitalized bipolar patients.Methods: Eighty-two patients aged between 18 and 49 were eligible to participate, as they met the DSM-IV criteria for a current manic episode, on the basis of a clinical interview by two academician psychiatrists. In addition, a score of at least 20 points on the Young Mania Rating Scale was required representing at least a moderate-to-severe mania. Forty-one patients were randomly allocated to lithium (1-1.2 mEq/L) + haloperidol (10 mg/day) + allopurinol (300 mg/day) (group A) or lithium (1-1.2 mEq/L) + haloperidol (10 mg/day) + placebo (group B) for an 8-week, double-blind, placebo-controlled study. Patients were assessed by a third-year resident of psychiatry at baseline and at 7, 14, 28, 42, and 56 days after the medication started. The mean decrease in the Young Mania Rating Scale score from baseline was used as the main outcome measure of response of mania to treatment. The extrapyramidal symptoms were assessed using the Extrapyramidal Symptoms Rating Scale (ESRS). Side effects were systematically recorded throughout the study and were assessed using a checklist.Results: Young Mania Rating Scale scores improved with allopurinol. The difference between the two protocols was significant as indicated by the effect of the group, the between-subjects factor (F = 5.22, df = 1, p = 0.008). The mean ESRS scores for the placebo group were higher than the allopurinol group. However, the differences were not significant over the trial. The difference between the two groups in the frequency of side effects was not significant except for agitation that was more often in the placebo group.Conclusions: The efficacy of allopurinol to obtain a greater improvement in patients with mania seems to support the purinergic dysfunction in mania.