Background:Although clozapine is an effective option for treatment-resistant schizophrenia(TRS),there are still 1/3 to 1/2 of TRS patients who do not respond to clozapine.The main purpose of this randomized,double-bli...Background:Although clozapine is an effective option for treatment-resistant schizophrenia(TRS),there are still 1/3 to 1/2 of TRS patients who do not respond to clozapine.The main purpose of this randomized,double-blind,placebocontrolled trial was to explore the amisulpride augmentation efficacy on the psychopathological symptoms and cognitive function of clozapine-resistant treatment-refractory schizophrenia(CTRS)patients.Methods:A total of 80 patients were recruited and randomly assigned to receive initial clozapine plus amisulpride(amisulpride group)or clozapine plus placebo(placebo group).Positive and Negative Syndrome Scale(PANSS),Scale for the Assessment of Negative Symptoms(SANS),Clinical Global Impression(CGI)scale scores,Repeatable Battery for the Assessment of Neuropsychological Status(RBANS),Treatment Emergent Symptom Scale(TESS),laboratory measurements,and electrocardiograms(ECG)were performed at baseline,week 6,and week 12.Results:Compared with the placebo group,amisulpride group had a lower PANSS total score,positive subscore,and general psychopathology subscore at week 6 and week 12(PBonferroni<0.01).Furthermore,compared with the placebo group,the amisulpride group showed an improved RBANS language score at week 12(PBonferroni<0.001).Amisulpride group had a higher treatment response rate(P=0.04),lower scores of CGI severity and CGI efficacy at week 6 and week 12 than placebo group(PBonferroni<0.05).There were no differences between the groups in body mass index(BMI),corrected QT(QTc)intervals,and laboratory measurements.This study demonstrates that amisulpride augmentation therapy can safely improve the psychiatric symptoms and cognitive performance of CTRS patients.展开更多
BACKGROUND Treatment-refractory schizophrenia(TRS),accounting for approximately 30%of all schizophrenia cases,has poor treatment response and prognosis despite treatment with antipsychotic drugs.AIM To analyze the the...BACKGROUND Treatment-refractory schizophrenia(TRS),accounting for approximately 30%of all schizophrenia cases,has poor treatment response and prognosis despite treatment with antipsychotic drugs.AIM To analyze the therapeutic effectiveness of repetitive transcranial magnetic stimulation(rTMS)combined with olanzapine(OLZ)and amisulpride(AMI)for TRS and its influence on the patient’s cognitive function.METHODS This study enrolled 114 TRS patients who received treatment at the First Affiliated Hospital of Zhengzhou University between July 2019 and July 2022.In addition to the basic OLZ+AMI therapy,54 cases of the control group(Con group)received modified electroconvulsive therapy,while 60 cases of the research group(Res group)received rTMS.Data on therapeutic effectiveness,safety(incidence of drowsiness,headache,nausea,vomiting,or memory impairment),Positive and Negative Symptom Scale,Montreal Cognitive Assessment Scale,and Schizophrenia Quality of Life Scale were collected from both cohorts for comparative analyses.RESULTS The Res group elicited a higher overall response rate and better safety profile when compared with the Con group.Additionally,a significant reduction was observed in the post-treatment Positive and Negative Symptom Scale and Schizophrenia Quality of Life Scale scores of the Res group,presenting lower scores than those of the Con group.Furthermore,a significant increase in the Montreal Cognitive Assessment Scale score was reported in the Res group,with higher scores than those of the Con group.CONCLUSION The treatment of TRS with rTMS and OLZ+AMI is effective and safe.Moreover,it can alleviate the patients’mental symptoms,improve their cognitive function and quality of life,and has a high clinical application value.展开更多
目的对比分析阿立哌唑与氯氮平治疗难治性精神分裂症(TRS)的疗效和不良反应。方法应用国际Cochrane协作网系统评价方法评价阿立哌唑与氯氮平治疗TRS的临床随机对照试验(RCT)。计算机检索Pubmed、Cochrane临床对照试验资料库、CNKI、万...目的对比分析阿立哌唑与氯氮平治疗难治性精神分裂症(TRS)的疗效和不良反应。方法应用国际Cochrane协作网系统评价方法评价阿立哌唑与氯氮平治疗TRS的临床随机对照试验(RCT)。计算机检索Pubmed、Cochrane临床对照试验资料库、CNKI、万方数据库、维普数据库,检索的起止时间为建库至2017年8月31日。纳入阿立哌唑与氯氮平治疗TRS的RCT文献10篇,由2名评价者独立提取资料并进行质量评估。RCT数据的Meta分析采用Excel软件和Cochrane协作网提供的Rev Man 5.3软件。结果阿立哌唑与氯氮平治疗TRS的疗效比较差异无统计学意义[OR 1.05,95%CI(0.76,1.44),P>0.05];但阿立哌唑引起的不良反应显著少于氯氮平(P<0.05或P<0.01)。结论现有临床证据表明,阿立哌唑治疗TRS的疗效与氯氮平相仿,但阿立哌唑不良反应少。展开更多
目的采用Meta分析方法评价氯氮平联合阿立哌唑治疗难治性精神分裂症(TRS)的安全性。方法在中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、CINAHL、Science Direct、Wliey Online Library、Web of science数据库中...目的采用Meta分析方法评价氯氮平联合阿立哌唑治疗难治性精神分裂症(TRS)的安全性。方法在中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、CINAHL、Science Direct、Wliey Online Library、Web of science数据库中搜索与氯氮平联合阿立哌唑治疗TRS患者安全性相关的随机对照实验(RCT),检索时间为建库至2018年8月20日。采用Rev Man 5.3统计学软件进行Meta分析。结果最终纳入11篇RCT文献。Meta分析结果显示,研究组在静坐不能、便秘、流涎、嗜睡及头晕等方面的安全性高于对照组[静坐不能:RR=2.31,95%CI(1.16,4.63),P=0.02;便秘:RR=0.14,95%CI(0.04,0.45),P=0.001;流涎:RR=0.11,95%CI(0.03,0.44),P=0.002;嗜睡:RR=0.23,95%CI(0.12,0.43),P<0.00001;头晕:RR=0.19,95%CI(0.07,0.52),P=0.001]。在失眠、肝功能异常、焦虑方面的安全性比较,差异无统计学意义[失眠:RR=1.23,95%CI(0.30,5.12),P=0.77;肝功能异常:RR=0.5,95%CI(0.26,0.99),P=0.05;焦虑:RR=0.89,95%CI(0.14,5.53),P=0.90]。结论氯氮平联合阿立哌唑治疗TRS安全性较高,可作为治疗TRS患者的方案之一。展开更多
Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and s...Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and several pharmacological strategies are used to augment it. Several reviews including meta-analyses have been published, but the efficacy of augmentation therapy for clozapine-resistant patients is not adequately supported. Though there is a weak connection between the oral dose and plasma concentration of clozapine, there is no report of augmentation therapy considering the plasma concentration of clozapine. Blonanserin is reported to be effective in treatment of both positive and negative symptoms of schizophrenia and well tolerated. Methods: We obtained consent to evaluate clinical presentations and clozapine plasma concentrations at the Okayama Psychiatric Medical Center and had not identified the individual for ethical reasons. This is a case report. Results: This case fulfilled the diagnostic criteria of neuroleptic-induced dopamine supersensitivity psychosis. Monotherapy with blonanserin was not effective, but augmentation of blonanserin with clozapine was effective and well tolerated by a clozapine-resistant schizophrenia patient. Conclusion: Because clozapine may ameliorate dopamine supersensitivity psychosis, the addition of blonanserin to clozapine may be effective even if monotherapy with blonanserin was not.展开更多
基金supported by the National Natural Science Foundation of China(81401127)the Clinical Research Project of Shanghai Municipal Health Commission(20204Y0173)+4 种基金the Open Project Program of State Key Laboratory of Virtual Reality Technology and Systems,Beihang University(VRLAB2022 B02)the Shanghai Key Laboratory of Psychotic Disorders Open Grant(21-K03)the Scientific Research Project of Traditional Chinese Medicine of Guangdong(20192070)the Guangzhou Municipal Key Discipline in Medicine(2021–2023)the Science and Technology Plan Project of Guangdong Province(2019B030316001).
文摘Background:Although clozapine is an effective option for treatment-resistant schizophrenia(TRS),there are still 1/3 to 1/2 of TRS patients who do not respond to clozapine.The main purpose of this randomized,double-blind,placebocontrolled trial was to explore the amisulpride augmentation efficacy on the psychopathological symptoms and cognitive function of clozapine-resistant treatment-refractory schizophrenia(CTRS)patients.Methods:A total of 80 patients were recruited and randomly assigned to receive initial clozapine plus amisulpride(amisulpride group)or clozapine plus placebo(placebo group).Positive and Negative Syndrome Scale(PANSS),Scale for the Assessment of Negative Symptoms(SANS),Clinical Global Impression(CGI)scale scores,Repeatable Battery for the Assessment of Neuropsychological Status(RBANS),Treatment Emergent Symptom Scale(TESS),laboratory measurements,and electrocardiograms(ECG)were performed at baseline,week 6,and week 12.Results:Compared with the placebo group,amisulpride group had a lower PANSS total score,positive subscore,and general psychopathology subscore at week 6 and week 12(PBonferroni<0.01).Furthermore,compared with the placebo group,the amisulpride group showed an improved RBANS language score at week 12(PBonferroni<0.001).Amisulpride group had a higher treatment response rate(P=0.04),lower scores of CGI severity and CGI efficacy at week 6 and week 12 than placebo group(PBonferroni<0.05).There were no differences between the groups in body mass index(BMI),corrected QT(QTc)intervals,and laboratory measurements.This study demonstrates that amisulpride augmentation therapy can safely improve the psychiatric symptoms and cognitive performance of CTRS patients.
文摘BACKGROUND Treatment-refractory schizophrenia(TRS),accounting for approximately 30%of all schizophrenia cases,has poor treatment response and prognosis despite treatment with antipsychotic drugs.AIM To analyze the therapeutic effectiveness of repetitive transcranial magnetic stimulation(rTMS)combined with olanzapine(OLZ)and amisulpride(AMI)for TRS and its influence on the patient’s cognitive function.METHODS This study enrolled 114 TRS patients who received treatment at the First Affiliated Hospital of Zhengzhou University between July 2019 and July 2022.In addition to the basic OLZ+AMI therapy,54 cases of the control group(Con group)received modified electroconvulsive therapy,while 60 cases of the research group(Res group)received rTMS.Data on therapeutic effectiveness,safety(incidence of drowsiness,headache,nausea,vomiting,or memory impairment),Positive and Negative Symptom Scale,Montreal Cognitive Assessment Scale,and Schizophrenia Quality of Life Scale were collected from both cohorts for comparative analyses.RESULTS The Res group elicited a higher overall response rate and better safety profile when compared with the Con group.Additionally,a significant reduction was observed in the post-treatment Positive and Negative Symptom Scale and Schizophrenia Quality of Life Scale scores of the Res group,presenting lower scores than those of the Con group.Furthermore,a significant increase in the Montreal Cognitive Assessment Scale score was reported in the Res group,with higher scores than those of the Con group.CONCLUSION The treatment of TRS with rTMS and OLZ+AMI is effective and safe.Moreover,it can alleviate the patients’mental symptoms,improve their cognitive function and quality of life,and has a high clinical application value.
文摘目的对比分析阿立哌唑与氯氮平治疗难治性精神分裂症(TRS)的疗效和不良反应。方法应用国际Cochrane协作网系统评价方法评价阿立哌唑与氯氮平治疗TRS的临床随机对照试验(RCT)。计算机检索Pubmed、Cochrane临床对照试验资料库、CNKI、万方数据库、维普数据库,检索的起止时间为建库至2017年8月31日。纳入阿立哌唑与氯氮平治疗TRS的RCT文献10篇,由2名评价者独立提取资料并进行质量评估。RCT数据的Meta分析采用Excel软件和Cochrane协作网提供的Rev Man 5.3软件。结果阿立哌唑与氯氮平治疗TRS的疗效比较差异无统计学意义[OR 1.05,95%CI(0.76,1.44),P>0.05];但阿立哌唑引起的不良反应显著少于氯氮平(P<0.05或P<0.01)。结论现有临床证据表明,阿立哌唑治疗TRS的疗效与氯氮平相仿,但阿立哌唑不良反应少。
文摘目的采用Meta分析方法评价氯氮平联合阿立哌唑治疗难治性精神分裂症(TRS)的安全性。方法在中国知网(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、CINAHL、Science Direct、Wliey Online Library、Web of science数据库中搜索与氯氮平联合阿立哌唑治疗TRS患者安全性相关的随机对照实验(RCT),检索时间为建库至2018年8月20日。采用Rev Man 5.3统计学软件进行Meta分析。结果最终纳入11篇RCT文献。Meta分析结果显示,研究组在静坐不能、便秘、流涎、嗜睡及头晕等方面的安全性高于对照组[静坐不能:RR=2.31,95%CI(1.16,4.63),P=0.02;便秘:RR=0.14,95%CI(0.04,0.45),P=0.001;流涎:RR=0.11,95%CI(0.03,0.44),P=0.002;嗜睡:RR=0.23,95%CI(0.12,0.43),P<0.00001;头晕:RR=0.19,95%CI(0.07,0.52),P=0.001]。在失眠、肝功能异常、焦虑方面的安全性比较,差异无统计学意义[失眠:RR=1.23,95%CI(0.30,5.12),P=0.77;肝功能异常:RR=0.5,95%CI(0.26,0.99),P=0.05;焦虑:RR=0.89,95%CI(0.14,5.53),P=0.90]。结论氯氮平联合阿立哌唑治疗TRS安全性较高,可作为治疗TRS患者的方案之一。
文摘Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and several pharmacological strategies are used to augment it. Several reviews including meta-analyses have been published, but the efficacy of augmentation therapy for clozapine-resistant patients is not adequately supported. Though there is a weak connection between the oral dose and plasma concentration of clozapine, there is no report of augmentation therapy considering the plasma concentration of clozapine. Blonanserin is reported to be effective in treatment of both positive and negative symptoms of schizophrenia and well tolerated. Methods: We obtained consent to evaluate clinical presentations and clozapine plasma concentrations at the Okayama Psychiatric Medical Center and had not identified the individual for ethical reasons. This is a case report. Results: This case fulfilled the diagnostic criteria of neuroleptic-induced dopamine supersensitivity psychosis. Monotherapy with blonanserin was not effective, but augmentation of blonanserin with clozapine was effective and well tolerated by a clozapine-resistant schizophrenia patient. Conclusion: Because clozapine may ameliorate dopamine supersensitivity psychosis, the addition of blonanserin to clozapine may be effective even if monotherapy with blonanserin was not.
