马燕;杜亚松;李方捷;李红;钱昀;江文庆;赵志民;毛叶萌;

• 1:上海交通大学医学院附属精神卫生中心药剂科
• 2:上海交通大学医学院附属精神卫生中心儿少科

摘要(Abstract)：

目的探讨精神专科儿童青少年患者使用抗精神病药物的情况。方法分析非典型抗精神病药物的使用情况,了解儿童精神分裂症患者的药物选择、剂量范围、联合用药、药品不良反应的发生等情况。结果 90例患者选择抗精神病药物(以奥氮平、利培酮、阿立哌唑和喹硫平为主)治疗。治疗前后BPRS评定及分量表比较,临床疗效根据BPRS减分率判定,患者出院时临床显效24例(26.7%),有效49例(54.4%),无效17例(18.9%)。住院期间,联合或换用精神科药物品种数≥3种的有64例(占71.1%)。出院时单用抗精神病药者34例(占37.78%),2种抗精神病药联用者38例(占42.22%),3种抗精神病药联用者7例(占7.78%)。治疗期间,奥氮平和喹硫平的最大剂量超出欧盟批准的抗精神病药最大剂量(成人),奥氮平、利培酮和阿立哌唑的最大剂量超出NICE推荐的儿童青少年精神病治疗的最大剂量范围。药物不良反应主要以锥体外系反应(14.15%)、垂体泌乳素升高和闭经(10.85%)、心电图异常(8.02%)、便秘(5.19%)、肝功能异常(4.25%)为主。不良反应发生率较高的是利培酮(在利培酮组中占76.09%)、奥氮平(在利培酮组中占50.85%);喹硫平和阿立哌唑组不良反应发生率较低。结论非典型抗精神病药物对儿童青少年精神分裂症的阳性和阴性症状均有效。在治疗过程中,尤其是大剂量治疗时,监测体重、代谢、内分泌等相关指标的变化,通过血药浓度、药物基因检测结果来综合评估,确定或调整抗精神病药物的剂量。尽量单一用药、缓慢加量,避免不良反应的发生,提高患者用药依从性。

关键词(KeyWords)： 儿童;青少年;精神分裂症;抗精神病药物;不良反应

Abstract:

Keywords:

基金项目(Foundation): 上海交通大学医学院科研课题青年项目(JDYX2017QN019)

作者(Author): 马燕;杜亚松;李方捷;李红;钱昀;江文庆;赵志民;毛叶萌;

Email:

DOI: 10.14053/j.cnki.ppcr.201910013

参考文献(References)：

• [1] Nunn K,Dey C.The Clinican′s guide to psychotropic prescribing in children and adolescents[M].Sydney:Glade Publishing;2003.
• [2] David T,Carol P,Shitij K.Maudsley 精神科处方指南[M].第12版.司天梅,译.北京:人民卫生出版社,2017.
• [3] Lee ES,Vidal C,Findling RL.A focused review on the treatment of pediatric patients with atypical antipsychotics[J].J Child Adolesc Psychopharmacol,2018,28(9):582-605.
• [4] Bachmann CJ,Rieger-Gies A,Heinzel-Gutenbrunner M,et al.Large variability of aripiprazole and dehydroaripiprazole serum concentrations in adolescent patients with schizophrenia[J].Ther Drug Monit,2008,30(4):462-466.
• [5] Bachmann CJ,Haberhausen M,Heinzel-Gutenbrunner M,et al.Large intraindividual variability of olanzapine serum concentrations in adolescent patients[J].Ther Drug Monit,2008,30(1):108-112.
• [6] Theisen FM,Haberhausen M,Schulz E,et al.Serum levels of olanzapine and its N-desmethyl and 2-hydroxymethyl metabolites in child and adolescent psychiatric disorders:effects of dose,diagnosis,age,sex,smoking,and comedication[J].Ther Drug Monit,2006,28(6):750-759.
• [7] Best-Shaw L,Gudbrandsen M,Nagar J,et al.Psychiatrists′ perspectives on antipsychotic dose and the role of plasma concentration therapeutic drug monitoring[J].Ther Drug Monit,2014,36(4):486-493.
• [8] Pagsberg AK,Tarp S,Glintborg D,et al.Antipsychotic treatment for children and adolescents with schizophrenia spectrum disorders:protocol for a network meta-analysis of randomised trials[J].BMJ Open,2014,4(10):e005708.
• [9] Newcomer JW,Haupt DW,Fucetola R,et al.Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia[J].Arch Gen Psychiatry,2002,59(4):337-345.
• [10] Guo JJ,Keck PE,Corey-Lisle PK,et al.Risk of diabetes mellitus associated with atypical antipsychotic use among patients with bipolar disorder:a retrospective,population-based,case-control study[J].J Clin Psychiatry,2006,67(7):1055-1061.
• [11] Bobes J,Arango C,Aranda P,et al.Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics:results of the CLAMORS Study[J].Schizophr Res,2007,90(1-3):162-173.
• [12] Stafford MR,Mayo-Wilson E,Loucas CE,et al.Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children,adolescents and young adults:a systematic review and meta-analysis[J].PLoS One,2015,10(2):e0117166.