奥氮平合并碳酸锂治疗女性急性躁狂发作的疗效及依从性

Efficacy and medication adherence of olanzapine, risperidone or clozapine combined with lithium in the treatment of acute mania in women

目的探讨使用奥氮平、利培酮、氯氮平3种非典型抗精神病药分别合并碳酸锂治疗女性躁狂发作疗效和院外服药依从性。方法按照随机的原则将84例女性患者分为3组,分别使用奥氮平、氯氮平、利培酮合并碳酸锂治疗,在急性期不少于4周的住院期间使用Bech-Rafaelsen躁狂量表(BRMS)、临床总体印象量表(CGI)评估疗效;院外治疗期8周内,应用在Morisky问卷基础上改进的自编依从性问卷对患者及其家属进行调查。结果住院期间奥氮平组起效时间中位数为3d,明显早于利培酮组的(7d)(Z=4.75,P<0.01);奥氮平组与氯氮平组(3d)的起效时间差异无统计学意义;治疗2周、4周后奥氮平组BMRS减分值与氯氮平组相当(Z=0.54、0.67,P=0.40、0.49),而大于利培酮组(Z=3.04、1.98,P<0.01、P=0.04)。随访期间奥氮平组服药依从性评分高于其他两组。结论奥氮平应用于女性急性躁狂发作患者起效迅速,维持治疗时服药依从性良好,其常见不良反应为过度镇静、头晕和体质量增加。

Objective： To explore efficacy and medication adherence of three kinds of atypical antipsychotics combined with lithium in the treatment of acute mania in women. Methods： Eighty - four female patients with acute mania were randomly divided into three groups and received olanzapine, risperidone or clozapine combined with lithium. Acute phase efficacy during hospitalization period was evaluated for at least 4 weekws, using Bech - Rafaelsen manic scale and clinic global impression. Medication adherence during fallow - up period was examined for 8 weeks, using self - made scales based Morisky＇s questionnaire, as rated by patients and their family members. Results：Median time to onset of action during hospitalization period for olanzapine group was 3 days, significantly shorter than that of risperidone （7 days） （ Z = 4.75 ,P 〈 O. 01 ）. There was no significant difference between clozapine （ 3 days） and olanzapine in term of time to onset of action. At week 2 and week 4, reduction in BRMS scores was comparable between olanzapine and clozapine groups （Z = 0.54,0.67 ,P = 0.40,0.49 ）, and was significantly larger in olanzapine group than in risperidone group （ Z = 3.04,1.98, P 〈 O. 01, P = 0.04 ）. Score of adherence during follow - up period was higher in olanzapine group than in risperidone and clozapine groups. Conclusion：Olanzapine combined with lithium has more rapid onset of action in female patients with acute mania and has good adherence during follow - up period. Common adverse events include over - sedation, dizziness and weight gain.