抗精神病药物治疗的“三五”原则

“Triple-five”principles of antipsychotic treatment

“三五”原则是指：(1)选药的“五要”原则,即有效、安全、便宜、方便及易换；(2)确保安全的“五不要”守则,即避免锥体外症候群、高催乳素血症、并用抗精神病药物、与抗胆碱能药物联用及体重增加；(3)必须停药(或换药)的5种最“要不得”意外,即抗精神病药物恶性症候群、粒性白血球缺乏症、急性心肌炎、心室性传导障碍及新发Ⅱ型糖尿病。

This article reviews guidelines for the choice of antipsychotics in the treatment of schizophrenia. At least five major factors are essential for the consideration in clinical practice. These include efficacy, adverse reactions, costs, convenience of use and easy to switch. Moreover, five important safety considerations which should be emphasized in the selection and use of first-line atypical antipsychotics are listed as follows： （1） to avoid extrapyramidal symptoms; （2） to avoid hyperprolactinemia; （3） to avoid antipsychotic polypharmacy; （4） to avoid anticholinergic medication; and （5） to avoid weight gain. In addition, five serious adverse reactions may require switching to an alternative agent. These include： （1） neuroleptic malignant syndrome; （2） agranulocytosis; （3） myocarditis; （4） cardiac rhythm abnormalities; and （5） impaired glucose tolerance.