НЕЙРОЛЕПТИКИ В ЛЕЧЕНИИ ШИЗОФРЕНИИ (ОБЗОР ЛИТЕРАТУРЫ)
Ключевые слова:
нейролептики, терапия шизофрении, побочные эффекты терапии антипсихотиками.
Аннотация
Цель. Рассмотреть ситуацию применения нейролептиков как основных фармакологических средств для лечения шизофрении как хронического психического заболевания, представленного рядом позитивных, негативных, когнитивных и аффективных симптомов, приводящих в итоге к дезорганизации психической деятельности и психической дезадаптации пациентов. Результаты. Приведены данные об отсутствии существенных различий в эффективности антипсихотических препаратов в отношении позитивных симптомов и симптомов психической дезорганизации, за исключением преимущества клозапина при лечении резистентных случаев. Показано, что эффективность терапии с точки зрения терапии негативных, депрессивных и когнитивных симптомов определяется в зависимости от: (1) того, в какой степени редукция позитивных симптомов (бреда и галлюцинации) способствует улучшению вторичных симптомов заболевания, и (2) от того, в какой степени побочные экстрапирамидные эффекты (EPSE) и побочные антихолинергические эффекты корректируются медикаментами, применяемыми для влияния на EPSE, ухудшая вышеупомянутые симптомы. Обосновано мнение о том, что нейролептики с сильным антипсихотическим действием без сопутствующих экстрапирамидных расстройств, не вызывающие необходимость сопутствующей антихолинэргической терапии, имеют большие терапевтические преимущества. Заключение. Рассмотрено, что, несмотря на общую схожесть в эффективности, все нейролептики существенно отличаются по частоте и интенсивности побочных эффектов. Вопреки мнению о том, что нейролептики второго поколения (так называемые атипичные нейролептики), как правило, считаются препаратами с меньшим, чем у классических антипсихотических препаратов, риском возникновения экстрапирамидных расстройств и с большим риском метаболических побочных эффектов, значительная вариация частоты этих и других побочных эффектов этих двух классов лекарственных средств свидетельствует, что такое категорическое различие фармакологических средств не является клинически оправданным. Выбор антипсихотического препарата должен основываться на индивидуальных предпочтениях пациентов, их терапевтической реакции на предшествующее лечение, анамнестических данных о наличии и характере побочных эффектов терапии нейролептиками, медицинских данных о факторах риска, уровне комплайенности и приверженности предписанного лечения, и, особенно, профиле побочных эффектов различных антипсихотиков.Литература
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23. Kapur S., Mizrahi R., Li M. From Dopamine to Salience to Psychosis-Linking Biology, Pharmacology and Phenomenology of Psychosis. Schizophr Res., 2005, vol. 79(1), pp. 59–68. DOI: 10.1016/j.schres.2005.01.003
24. Keefe R.S., Bilder R.M., Davis S.M. Neurocognitive Working Group. Neurocognitive Effects of Antipsychotic Medications in Patients with Chronic Schizophrenia in the CATIE Trial. Arch Gen Psychiatry, 2007, vol. 64(6), pp. 633–647. DOI: 10.1001/archpsyc.64.6.633
25. Kinon B.J., Chen L., Ascher-Svanum H. Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Respons in the Treatment of Schizophrenia. Neuropsychopharmacology, 2010, vol. 35(2), pp. 581–590. DOI: 10.1038/npp.2009.164
26. Leucht S., Barnes T.R.E., Kissling W. Relapse Prevention in Schizophrenia with New-Generation Antipsychotics: a Systematic Review and Exploratory Meta-Analysis of Randomized, Controlled Trials. Am J Psychiatry, 2003, vol. 160(7), pp. 1209–1222. DOI: 10.1176/appi.ajp.160.7.1209
27. Leucht S., Busch R., Hamann J. Early-Onset Hypothesis of Antipsychotic Drug Action: a Hypothesis Tested, Confirmed and Extended. Biol Psychiatry, 2005, vol. 57(12), pp. 1543–1549. DOI: 10.1016/j.biopsych.2005.02.023
28. Leucht S., Corves C., Arbter D. Second-Generation Versus First-Generation Antipsychotic Drugs for Schizophrenia: a Meta-Analysis. Lancet, 2009, vol. 373(9657), pp. 31–41. DOI: 10.1016/S0140-6736(08)61764-X
29. Leucht S., Arbter D., Engel R.R. How Effective are Second-Generation Antipsychotic Drugs? A Meta-Analysis of Placebo-Controlled Trials. Mol Psychiatry, 2009, vol. 14(4), pp. 429–447. DOI: 10.1038/sj.mp.4002136
30. Leucht S., Komossa K., Rummel-Kluge C. A Meta-Analysis of Head-to-Head Comparisons of Second-Generation Antipsychotics in the Treatment of Schizophrenia. Am J Psychiatry, 2009, vol. 166(2), pp. 152–163. DOI: 10.1176/appi.ajp.2008.08030368
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References
Опубликован
2016-09-01
Как цитировать
Стойчев, К., Иванов, К., Кожухаров, Х., Хрусафов, Д., Александрова, М., & Бъркашка, Д. (2016). НЕЙРОЛЕПТИКИ В ЛЕЧЕНИИ ШИЗОФРЕНИИ (ОБЗОР ЛИТЕРАТУРЫ). Человек. Спорт. Медицина, 16(3), 25-36. https://doi.org/10.14529/hsm160304
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Клиническая и экспериментальная медицина
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