抗精神病藥
抗精神病藥 | |
---|---|
藥物種類 | |
奧氮平,一種第二代抗精神病藥 | |
用途 | 治療範圍:精神分裂症,分裂情感性障礙,痴呆症,妥瑞症,躁鬱症,自閉症譜系 |
外部連結 | |
MeSH | D014150 |
AHFS/Drugs.com | 藥物分類 |
抗精神病藥(antipsychotic)是精神活性藥物的一種[1],可在不影響意識清醒的條件下,控制興奮、躁動、幻覺及妄想等症狀。主要用於治療思覺失調症,此類藥物也用於應對和治療一些其他精神障礙,而抗精神病藥和心境穩定劑的共同使用,也對雙相障礙的治療有很大助益[2]。
抗精神病藥舊稱抗精神分裂症藥物[3][4](antischizophrenic drug)、神經阻滯劑[5][1][6](neuroleptic)、強安定劑[7](major tranquilizer)。
抗精神病藥分為兩大類:典型抗精神病藥物(第一代抗精神病藥物)、非典型抗精神病藥物(第二代抗精神病藥物),後者引起錐體外系症狀(EPS)和遲發性運動障礙(TD)的風險通常較低[8][9]。
服用抗精神病藥物可能會導致許多有害的副作用,如錐體外系反應、男性乳腺發育、勃起功能障礙、體重增加和代謝症候群。使用抗精神病藥物還會造成長期不良影響,如遲發性運動障礙。對於體重增加和代謝症候群,可以通過在開始使用抗精神病藥時同時起用二甲雙胍預防。[10][11]
抗精神病藥物的使用會導致部分腦組織體積變小,而且這種變化是根據用藥劑量和時間所反映出不同的情況表現[12][13]。抗精神病藥物所抑制的病症作也會降低大腦體積,因此應權衡利弊,要避免不必要使用,也要儘量避免發作。[14]第二代抗精神病藥物相比第一代,造成腦組織變小的程度已小很多。短期使用(藥物配合intensive psychosocial therapy [IPT]相比只接受IPT者)能加速思覺失調患者蒼白球灰質體積的恢復,而體積恢復程度和病情改善正相關。[15]暫時沒有發現這類藥物會增加痴呆的風險。[16]
抗精神病藥在法語中作neuroleptiques,1950年代由法國醫生Henri Laborit發現,並應用於臨床。
用途
[編輯]用於
- 精神分裂症[17]
- 分裂情感障礙,一般配合抗抑鬱藥(如果是抑鬱型的)或情緒穩定劑(如果是雙相型的)。抗精神病藥本身可以穩定情緒,因此也可以獨用。
- 雙相障礙中急性躁狂發作和急性混合性發作都可以使用抗精神病藥壓制。典型、非典型均可,但非典型的副作用更小,[18]也更少導致轉入抑鬱發作。[19]
- 思覺失調性抑鬱症:一般複合使用抗精神病藥和抗抑鬱藥。[20]對發作有效果,但在病情緩解之後繼續維持使用有弊無益。[21]
- 難治性抑鬱症:可以作為抗抑鬱藥的附加治療,[20]確實可以提高控制抑鬱的能力,[22]但提升不多。由於副作用也多,從平均意義而言對生活質量沒有改善。[23]
分類
[編輯]從化學結構上看,抗精神病藥可分成
- 吩噻嗪類抗精神病藥
- 噻噸類抗精神分裂藥(硫雜蒽類抗精神病藥)
- 丁醯苯類抗精神病藥
- 二苯氮䓬類抗精神病藥
- 二苯丁基哌啶類抗精神病藥
- 苯甲醯胺類抗精神病藥
- 非典型抗精神病藥
參考文獻
[編輯]- ^ 1.0 1.1 Finkel RF, Clark MA, Cubeddu LX. Pharmacology. Lippincott Williams & Wilkins. 2009: 151. ISBN 9780781771559. (原始內容存檔於1 April 2017) (英語).
- ^ Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. Lancet. April 2016, 387 (10027): 1561–1572. PMID 26388529. S2CID 205976059. doi:10.1016/S0140-6736(15)00241-X.
- ^ Snyder S, Greenberg D, Yamamura HI. Antischizophrenic drugs and brain cholinergic receptors. Affinity for muscarinic sites predicts extrapyramidal effects. Arch Gen Psychiatry. 1974 Jul;31(1):58-61. doi: 10.1001/archpsyc.1974.01760130040006. PMID 4152054.
- ^ Gould RJ, Murphy KM, Reynolds IJ, Snyder SH. Antischizophrenic drugs of the diphenylbutylpiperidine type act as calcium channel antagonists. Proc Natl Acad Sci U S A. 1983 Aug;80(16):5122-5. doi: 10.1073/pnas.80.16.5122. PMID 6136040; PMCID: PMC384201.
- ^ 倪倩,徐印芝,李紅玲.抗精神病藥物的不良反應和處理[J].工企醫刊, 2003, 16(5):1.DOI:10.3969/j.issn.1001-814X.2003.05.131.
- ^ 抗精神病藥 (頁面存檔備份,存於網際網路檔案館)[M/OL]//陳至立. 辭海. 7版. 上海:上海辭書出版社,2020[2024].
- ^ Burnett, GB. The assessment of thiothixene in chronic schizophrenia. A double-blind controlled trial.. Dis Nerv Syst. 1975, 36 (11): 625–9. PMID 1102277.
- ^ 存档副本. [2024-02-26]. (原始內容存檔於2024-02-26).
- ^ 存档副本. [2024-02-26]. (原始內容存檔於2024-02-26).
- ^ Praharaj SK, Jana AK, Goyal N, Sinha VK. Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis. British Journal of Clinical Pharmacology. March 2011, 71 (3): 377–82. PMC 3045546
. PMID 21284696. doi:10.1111/j.1365-2125.2010.03783.x.
- ^ Yu, O; Lu, M; Lai, TKY; Hahn, M; Agarwal, SM; O'Donoghue, B; Ebdrup, BH; Siskind, D. Metformin co-commencement at time of antipsychotic initiation for attenuation of weight gain: a systematic review and meta-analysis.. Therapeutic Advances in Psychopharmacology. 2024, 14: 20451253241255476. PMC 11141220
. PMID 38827016. doi:10.1177/20451253241255476
.
- ^ Ho, B; Andreasen, N. Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry. 2011, 68 (2): 128–37. PMC 3476840
. PMID 21300943. doi:10.1001/archgenpsychiatry.2010.199.
- ^ Moncrieff, J; Leo, J. A systematic review of the effects of antipsychotic drugs on brain volume. Psychological Medicine. 2011, 40 (9): 1409–22. PMID 20085668. S2CID 23522488. doi:10.1017/S0033291709992297.
- ^ Voineskos, Aristotle N.; Mulsant, Benoit H.; Dickie, Erin W.; Neufeld, Nicholas H.; Rothschild, Anthony J.; Whyte, Ellen M.; Meyers, Barnett S.; Alexopoulos, George S.; Hoptman, Matthew J.; Lerch, Jason P.; Flint, Alastair J. Effects of Antipsychotic Medication on Brain Structure in Patients With Major Depressive Disorder and Psychotic Features: Neuroimaging Findings in the Context of a Randomized Placebo-Controlled Clinical Trial. JAMA Psychiatry. 2020-07-01, 77 (7): 674. doi:10.1001/jamapsychiatry.2020.0036.
- ^ Chopra S, Fornito A, Francey SM, O'Donoghue B, Cropley V, Nelson B, et al. Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study. Neuropsychopharmacology. July 2021, 46 (8): 1494–1501. PMC 8209146
. PMID 33637835. doi:10.1038/s41386-021-00980-0.
- ^ Tournier, M; Pambrun, E; Maumus-Robert, S; Pariente, A; Verdoux, H. The risk of dementia in patients using psychotropic drugs: Antidepressants, mood stabilizers or antipsychotics.. Acta psychiatrica Scandinavica. 2022-01, 145 (1): 56–66. PMID 34689322. doi:10.1111/acps.13380.
- ^ Bartoli F, Cavaleri D, Callovini T, Riboldi I, Crocamo C, D'Agostino A, Martinotti G, Bertolini F, Ostuzzi G, Barbui C, Carrà G. Comparing 1-year effectiveness and acceptability of once-monthly paliperidone palmitate and aripiprazole monohydrate for schizophrenia spectrum disorders: Findings from the STAR Network Depot Study. Psychiatry Research. March 2022, 309: 114405. PMID 35093701. S2CID 246054926. doi:10.1016/j.psychres.2022.114405.
- ^ 引用錯誤:沒有為名為
Lancet2009
的參考文獻提供內容 - ^ Goikolea JM, Colom F, Torres I, Capapey J, Valentí M, Undurraga J, Grande I, Sanchez-Moreno J, Vieta E. Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol. Journal of Affective Disorders. January 2013, 144 (3): 191–8. PMID 23089129. doi:10.1016/j.jad.2012.07.038.
- ^ 20.0 20.1 Taylor D, Paton C, Kapur S, Taylor D. The Maudsley prescribing guidelines in psychiatry 11th. Chichester, West Sussex, UK: Wiley-Blackwell. 2012. ISBN 978-0-470-97948-8.
- ^ Al-Wandi, Ahmed; Landén, Mikael; Nordenskjöld, Axel. Antipsychotics in the maintenance phase for psychotic depression. Acta Psychiatrica Scandinavica. 2023-11-06, 149 (1): 6–17. ISSN 0001-690X. PMID 37932158. doi:10.1111/acps.13628
(英語).
- ^ Komossa K, Depping AM, Gaudchau A, Kissling W, Leucht S. Second-generation antipsychotics for major depressive disorder and dysthymia. The Cochrane Database of Systematic Reviews. December 2010, (12): CD008121. PMID 21154393. doi:10.1002/14651858.CD008121.pub2.
- ^ Spielmans GI, Berman MI, Linardatos E, Rosenlicht NZ, Perry A, Tsai AC. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLOS Medicine. 2013, 10 (3): e1001403. PMC 3595214
. PMID 23554581. doi:10.1371/journal.pmed.1001403
.