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1 ( ) R A (2005) : Medline Pubmed Ovid Science Direct Proquest : 10 ; ; ; ; ; ; Clinical Evaluation of Atypical Antipsychotics in the Treatment of Schizophrenia HUANGJizhong ZHANG Mingyuan (Shanghai Mental Health Center Shanghai ) ABSTRACT OBJ ECTIVE : To systematically review the aspects of clinical usage and research progress of atypical antipsychotics in the treatment of schizophrenia ( SP) and evaluate their clinical efficacy and safety. METHODS : To search medical literatures in resent years at Medline Pubmed Ovid Science Direct and Proquest by internet and some reports published on medical literatures at home and abroad for an analysis. RESULTS & CONCLUSION : Clinical use and research of atypical antipsychotics in the treatment of schizophrenia have been well - performed and the advancements have been swift. Most of new type of atypical antipsychotics such as risperidone olanzapine quetiapine ziprasidone and aripiprazole have already become the first line choice for the treatment of schizophrenia in different level different stage and prevention of recurrence except for clozapine. In particular they have obviously minimized side effects caused by classic antipsychotics and clozapine. Various clinical research results have been confirmed by many clinically systematic researches taking the method of evidence - based psychiatry. KEY WORDS atypical antipsychotics ; classic antipsychotics ; schizophrenia ; clinical trial ; clinical evaluation ; evidence - based psychiatry ; extrapyramidal symptoms ( EPSs) (atypical antipsychotics) D [1 ] 30 (classic antipsychotics) D 2 15 (Risperidone) (Olanzapine) (Quetiapine) ( EPSs) ( Ziprasidone) ( Amisulpiride) EPSs 60 % (Adpiprazolel) 50 % 50 % 1 20 % D 2 D 2 D 2 EPSs - EPSs D 2 - D 2 (PRL) 5 - (5 - HT) (NE) Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

2 D 2 ; 5 - HT 1A 2A 2C NE 1 2 ( ) HT 2A D 2 ; - ; EPSs mg/ ml 80 D 2 [1 2 ] (Zotepine) (Sertindole) 212 ( Olanzapine) mg/ d EPSs 10mgΠd [ ( ] ) 10 15mg ( 215mg) / d 2 10mgΠd (15 5) mgπd ( RCTs) (Meta ) 1 Medline Pubmed Ovid Science Direct Proquest 1 [8 10 ] Lindenmayer [11 ] 43 40mg/ d 20 40mgΠ d 1617 % ( Clozapine) 2015mgΠd 30316mgΠd Conley [12 ] mg/ d 418mg/ d 7712 % 7118 % [4 5 ] Kane PANSS / EPSs (35 % vs 67 %) Tran (57 % vs 25 %) [13 ] 2 1 [6 ] 1917 % 28 % ( P = 01034) Perry [14 ] Hagg 2312ngΠml [7 ] ;Cohen EPSs 6 - ; % 76 Evaluation and analysis of drug2use in hospitals of China 2005 Vol. 5 No Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

3 ; PRL Liebzeit 6mg/ d EPSs 60 % [15 ] 83 % EPSs [19 6 ] Kopala [20 ] 2 4mg/ d 5 8mg/ d PANSS mg/ d 80 % EPSs (3Π65) 2 4mg/ d Lane [21 ] 6mgΠd 60 % 213 ( Quetiapine) 40 % ( ) mg/ d EPSs - 12mgΠd 5 - HT 2 D 1 D 2 M EPSs Csemansky [22 ] 397 3h 6h mg/ d 800mg/ d (34 %/ 60 %) EPSs Purdon [16 ] 25 6 Markianos [23 ] 6 PRL EPSs Copolov [17 ] PRL PRL 1 6 PRL EPSs PRL Emesley [18 ] 1 8 RCT EPSs (PANSS) (BPRS) ( Path - EPSs PRL analysis) ( Risperidone) ( Ziprasidone) 5 - HT 5 - HT 2A - D HT NE DA 5 - HT 2A / D HT 1A 312h 10h mgΠd 20h 22h( ) mg/ d 2 1 8mg/ d 3 EPSs EPSs 10mg/ d 20mg/ d 1 ( ) Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

4 [24 25 EPSs ] PRL PRL ; ; [29 Q - Tc 1 ] FDA Q - Tc mg/ d FDA 2013ms (0106 %) Q - Tc ( > 500ms) (0123 %) Q - Tc > 500ms 218 ( Zotepine) Q - Tc 5 - HT DA H1 NE 1 NE (TCAs) 3d 4d Q - Tc mg/ d Q - Tc mg/ d 10 20mg/ d (Sotalol) (Sparfloxacin) EPSs ; BPRS EPSs ; ( Sertindole) 5 - HT 2A / D 2 Hwang [30 ] EPSs [31 1 ] 16mg/ d 24mg/ d FDA 10mg/ d 8mg/ d EPSs ( Aripiprazole) D 2 D 3 ( - D 2 D HT 1A 2A/ C ) Q - Tc Pezawas 5 - HT 1A 5 - HT 2A [26 ] 34 D 2 Q - Tc 1917ms D 2 - EPSs - DA PRL FDA 44h 70h 15 30mg/ d 2 10mg/ d D 2 [ ] EPSs PRL 217 ( Amisulpiride) Potkin mg/ d(n = 101) 30mgΠd (n = 101) D 2 D 3 (n = 103) 6mg/ d(n = 99) PANSS D 2 (CGI) 20mg/ d DA DA 30mgΠd 6mgΠd EPSs PRL 5 Q - Tc ( mg/ d) BPRS 5 40mg/ d P mg/ d Pigott (50 300mg/ d) MeQuade HT 2A D 2 EPSs EPSs - EPSs 78 Evaluation and analysis of drug2use in hospitals of China 2005 Vol. 5 No Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

5 [31 34 ] ; (3) 2110 ; (4) Volavka ; (5) mg/ d 1114 mg/ d EPSs PRL Q - Tc ; (6) [35 ] Davis (2003) Hedges - Olkin (LOCF) [ 1 ] Kinon BJ Lieberman JA. Mechanisms of action of atypical antipsychotic drugs : a critical analysis [ J ]. Psychopharma P cology :2. [2 ] Andersson C Chakos M Mailman R et al. Emerging roles for novel antipsychotic medications in the treatment of schizo2 6 phreniz[j ]. Psychiatr Clin north Am :151. (Ramoxipride) [3 ] Leysen J E Janssen PMF Schotte A et al. Interaction of an2 tipsychotic drugs with neurotransmitter receptor sites in vitro [36 ] and in vivo in relation to pharmacological and clinical effects : Leucht (1999) role of 5HT 2 receptors [J ]. Psychopharmacology : S40. [ 4 ] Kane JM Honigfeld G Singer J et al. Clozapine for the treatment - resistant schizophrenic. A double - blind compari2 son with chlorpromazine [J ]. Arch Gen Psychiatry : [37 EPSs ] [ 5 ] Meltzer HY McGurk SR. The effect of clozapine risperi2 done and olanzapine on cognitive function in schizophrenia [J ]. Schizophr Bull :233. [6 ] Rosenheck R Cramer J Xu W et al. A comparison of cloz2 apine and haloperidol in hospitalized patients with refractory D 2 schizophrenia[j ]. N Engl J Med :809. [7 ] Hagg S Spigset O Bate A et al. Myocarditis related to clozapine treatment [J ]. J Clin Psychopharmacol : 382. [8 ] Beasley CM Tollefson G Tran P et al. Olanzapine versus placebo and haloperidol[j ]. Neuropsychopharmacology :111. [9 ] Tollefson GD Beasley CM Tran PV et al. Olanzapine ver2 : (1) sus haloperidol in the treatment of schizophrenia and schizoaf2 fective and schizophreniform disorders :results of an internation2 ; (2) al collaborative trial[j ]. Am J Psychiatry : Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

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