Improving outcome in schizophrenia: the potential importance of EPS and neuroleptic dysphoria.
Improving outcome in schizophrenia: the potential importance of EPS and neuroleptic dysphoria.
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DOI：
10.1023/a:1015276028425
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发表时间：
2002-03-01
期刊：
影响因子：
--
通讯作者：
Gerlach, Jes
中科院分区：
文献类型：
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作者：
Gerlach, Jes
尽管抗精神病药物治疗已有半个世纪，但精神分裂症的治疗结果仍然令人失望。复发、再次住院、有限履行社会角色和自杀仍然频繁，经济成本很高。目前的复发率可能比通过最佳治疗可以达到的复发率高出两到三倍。治疗依从性差被认为是结果不佳的一个重要的可预防的原因，反过来又可能受到患者药物治疗经验的影响。有证据表明，锥体外系症状(EPS)，特别是静坐不能和抗精神病药焦虑症，与依从性差和治疗结果差有关。非典型抗精神病药物发生EPS的风险比标准抗精神病药物低。一些药物(利培酮、奥氮平和齐拉西酮)显示出与剂量相关的EPS增加的证据，但氯氮平和奎硫平在整个剂量范围内显示出安慰剂水平的EPS发生率。奎硫平不需要氯氮平规定的定期血液监测，患者调查结果表明患者对治疗的满意度很高。虽然还需要进一步的研究，但更广泛地使用低EPS和患者可接受性高的药物可能会促进更好的依从性，并改善精神分裂症治疗的结果。
Despite half a century of antipsychotic drug treatment, the outcome of therapy in schizophrenia remains disappointing. Relapse, rehospitalization, limited fulfilment of social roles, and suicide remain frequent, and the economic costs are high. Current relapse rates may be two to three times higher than those that could be achieved with optimal use of therapy. Poor compliance with treatment is considered to be a significant preventable cause of poor outcome and is in turn likely to be influenced by the patient's experience of drug treatment. There is some evidence that extrapyramidal symptoms (EPS), particularly akathisia and neuroleptic dysphoria, are associated with poor compliance and poor treatment outcome. Atypical antipsychotics have a lower risk of EPS than do standard antipsychotics. Some (risperidone, olanzapine, and ziprasidone) show evidence of a dose-related increase in EPS, but clozapine and quetiapine have demonstrated a placebo-level incidence of EPS across the dose range. Quetiapine does not require the regular blood monitoring mandated for clozapine, and results from a patient survey indicate a high degree of patient satisfaction with treatment. While further research is needed, it is possible that wider use of medications with low EPS and high patient acceptability could promote better compliance and improve the outcome of schizophrenia treatment.