有精神病性症状的躁狂发作患者近期疗效比较

A comparative study on short--term pharmacotherapeutic effects in manic episode patients with psychotic symptoms

目的比较单一经典抗精神病药物（奋乃静）或心境稳定剂（碳酸锂）合并小剂量经典抗精神病药物（奋乃静）治疗有精神病性症状的躁狂发作患者的疗效和安全性；探讨影响患者近期疗效的主要因素。方法（1）将符合入组标准的精神病性症状的躁狂发作患者70例随机分为甲组34例和乙组36例两组进行为期6周治疗。甲组为单一中至大剂量经典抗精神病药物（奋乃静）治疗；乙组为心境稳定剂（碳酸锂）合并中至小剂量经典抗精神病药物（奋乃静）治疗。以Bech—Rafaelsen躁狂量表（BRMs）和临床总体印象量表（CGI）评定患者的疗效，以不良反应症状量表（TESS）评定患者的副反应；（2）采用临床流行病学方法，探讨影响有精神病性症状的躁狂发作患者近期疗效的主要因素。结果（1）在治疗第6周末，甲组患者的临床治愈率38．2％，有效率94．1％（33／34）；乙组的临床治愈率63．9％，有效率100％（36／36），乙组在临床疗效及药物不良反应上均显著性优于甲组（P〈0．05）；（2）有精神病性症状的躁狂发作患者的近期疗效好，影响有精神病性症状的躁狂发作患者近期疗效的主要因素为患者的起病年龄、病前社会功能、病程特点及患者的精神病性症状与心境的协调性，以急性起病、病前社会功能良好、间歇性病程及患者的精神病性症状与患者心境相协调者的近期疗效为佳。结论（1）心境稳定剂合并小剂量经典抗精神病药物在治疗有精神病性症状的躁狂发作时，临床疗效优于单一经典抗精神病药物治疗且副反应相对少；（2）有精神病性症状的躁狂发作患者的近期疗效好，患者的近期疗效受多种因素的影响。

Objective To compare the efficacy combined with lithium in treating hospitalized manic and safety between perphenazine and perphenazine episode patients with psychotic symptoms, and to explore the major factors that influence short--term outcome of these patients. Methods （1）79 patients meeting the enrolled criteria were randomly assigned to receive perphenazine alone or combined with lithium for 6 weeks. The therapeutic efficacy and side effects were evaluated with Bench--Rafaelsen Mania Rating （BRMS）, Positive And Negative Symptoms Rating （PANSS）, Clinical Global Impression （CGI） and Treatment Emergent Symptom Scale （TESS） separately. （2） using epidemiological approaches, the major factors that affect short--term outcome of manic episode patients with psychotic symptoms were investigated. Results （1）6 weeks after treatment with the assigned regimen, the total scores of BRMS were significantly reduced in two groups. The cure rates were 38. 2% and 63. 9% for the patients treated with perphenazine alone and combined with lithium, respectively. The responsive rates were 94.1% and 100% for the patients treated with perphenazine alone and combined with lithium, respectively. Lower scores of side effects were showed in the patients treated combined medication. （2）the majority of hospitalized manic episode patients with psychotic features showed a favorable outcome during the acute treatment. The age of onset, character of course, premorbid levels of social functioning and congruence between mood and psychotic symptoms were major factors influencing the short--term outcome in manic episode patients with psychotic features. A better outcome was displayed in the patients with acute onset, better premorbid social functioning, intermittent course, and mood--congruent psychotic symp- toms. Conclusions （1）mood stabilizer combined with typical antipsychotics showed a better efficacy and tolerability than traditional antipsychotics alone in treating manic episode inpatients with psychotic symptoms. （2）the manic episode patients with psychotic symptoms usually have a favorable outcome, and that is influenced significantly by certain factors.