精神病臨床藥理及常用藥物(編輯修改稿)
2024-11-12 03:37 本頁面
【文章內(nèi)容簡介】 氮平 及其相關(guān)藥物 ) ? 氯氮平 ? 奧氮平 ? 奎硫平 ? 拮抗 5HT2/D2 抗精神病藥物 (由氟哌啶醇衍生而來 ) ? 利培酮 ?壽廷多 ? 齊哌西酮 From: Shen WW, Annales of Clinical Psychiatry 1999。 11: 3: 145157 抗精神病藥對多巴胺 D2受體的相對結(jié)合率 奎硫平 氯氮平 奧氮平 壽廷多 齊哌西酮 氯丙嗪 氟哌啶醇 氟奮乃靜 利培酮 100 10 1 “疏松” “緊密” 多巴胺 K ( nM) From: Seeman P and Tallerico T, Molecular Psychiatry 1998。 3:123134 ?? ?? ?? ?? ?? ?? ?? ?? ?? DA 突觸后神經(jīng)元 DA 突觸后神經(jīng)元 DA 突觸后神經(jīng)元 DA 突觸后神經(jīng)元 DA DA DA DA DA DA DA DA DA DA DA DA DA DA DA DA 結(jié)合力大 “ 緊密” 結(jié)合力中等或 “ 松散” 結(jié)合“緊密” 可導(dǎo)致DA受體上調(diào)，引起復(fù)發(fā)。更多導(dǎo)致 TD 結(jié)合“松散” 較少引起D2 受體上調(diào)，對內(nèi)源性 DA更具反應(yīng)，因此較少 EPS 和催乳素升高 Seeman, Talerico: Mol Psych 1998 3(2) Kapur, Seeman: J of Psych amp。 Neuro 2021:March D2 親合力差異對長期治療的影響 The Revised Dopamine Hypothesis of Schizophrenia ? Psychopharmacol Bull 41(1):121132, 2021 ? The revised dopamine (DA) hypothesis states that clinical symptoms of schizophrenia are caused by an imbalance of the DA system. ? we aim to review evidence for this hypothesis by evaluating functional magic resonance imaging studies in schizophrenia. ? Because atypical drugs are thought to have a normalizing effect on DA neurotransmission, we have focused on pharmacological MRI (PhMRI) studies that explore the effect of these drugs on prefrontal and striatal brain activity in schizophrenia patients. ? It was reported enhanced prefrontal activity associated with alleviation of negative symptoms and improvement of cognitive functions, following treatment with atypical antipsychotics. ? Besides increasing prefrontal cortex activity, atypical antipsychotics have also shown to be effective in the regulation of striatal functioning. ? The current PhMRI findings support the revised DA hypothesis of schizophrenia by confirming hypoactivity of the prefrontal cortex in schizophrenia and, following atypical antipsychotics, improvement of prefrontal and subcortical functions reflecting enhanced DA activity. CATIE and CUtLASS conclusions 正確評價第一代和第二代抗精神病藥 ? SGAs are not uniformly or consistently more effective than FGAs。 ? if differences in EPS and anticholinergic use between FGAs and SGAs can be liminated, then differences in effectiveness between them can be substantially diminished or even removed。 ? antipsychotic effectiveness in schizophrenia is still unsatisfactory。 pletion rate on initially assigned antipsychotic treatment arm at 18 months in CATIE was 26%。 ? different challenges exist in balancing efficacy and tolerability with different agents。 ? the process of switching antipsychotics can be risky。 ? given enormous individual variability in drug handling, responsivity, and susceptibility to and tolerance of different adverse effects, no single approach works for all patients。 ? clozapine is still the gold standard in the treatment of otherwise unresponsive schizophrenia. S
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號-1