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首页> 外文期刊>The journal of clinical psychiatry >Switching outpatients with bipolar or schizoaffective disorders and substance abuse from their current antipsychotic to aripiprazole.
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Switching outpatients with bipolar or schizoaffective disorders and substance abuse from their current antipsychotic to aripiprazole.

机译：将患有双相情感障碍或精神分裂症和药物滥用的门诊患者从目前的抗精神病药转到阿立哌唑。

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OBJECTIVE: Substance abuse is extremely common in patients with bipolar disorders, although minimal data are available on the treatment of this important clinical population. Aripiprazole is an atypical antipsychotic that is approved for the treatment of mania and that has a novel mechanism of action, acting as a dopamine-2 receptor partial agonist, thereby increasing dopamine release in some parts of the brain and decreasing dopa-mine release in other brain regions. Dopamine release is implicated in substance use, and both dopaminergic agonists and antagonists have been examined for the treatment of substance abuse. To our knowledge, dopa-mine receptor partial agonists have not been investigated for treatment of substance abuse in humans. METHOD: Twenty antipsychotic-treated patients with bipolar or schizoaffective disorder and current substance abuse were switched to open-label aripipra-zole using an overlap and taper method. At baseline, diagnoses were confirmed using the Mini-International Neuropsychiatric Interview based on DSM-IV criteria. Psychiatric symptoms, side effects, and substance use and craving were assessed over 12 weeks. Psychiatric symptoms were assessed with the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Substance craving was assessed with visual analogue scales, and side effects were monitored using the Abnormal Involuntary Movement Scale, Simpson-Angus Scale, Barnes Akathisia Scale, and patient report. Study enrollment was from April 2003 to February 2004. RESULTS: Significant baseline-to-exit improvement in HAM-D (p = .002), YMRS (p = .021), and BPRS (p = .000) scores were observed without a significant change in antipsychotic-induced side effect scales. In 17 participants with current alcohol dependence, significant reductions in dollars spent on alcohol (p = .042) and alcohol craving (p = .003) were found. In 9 participants with cocaine-related disorders, significant reductions in cocaine craving(p = .014), but not use, were found. CONCLUSION: A change to aripiprazole was associated with symptomatic improvement. Limitations of the study include a small sample size, high attrition, and an open-label design. Controlled trials in dual-diagnosis patients are needed to confirm these findings.
机译：目的：双相情感障碍患者中药物滥用极为普遍，尽管有关这一重要临床人群的治疗资料很少。阿立哌唑是一种非典型抗精神病药，已被批准用于治疗躁狂症，并且具有新颖的作用机制，可作为多巴胺2受体部分激动剂，从而增加大脑某些部位的多巴胺释放，并降低其他部位的多巴胺释放。脑区。多巴胺的释放与物质的使用有关，多巴胺能激动剂和拮抗剂均已被用于药物滥用的治疗。据我们所知，尚未研究多巴胺受体部分激动剂用于治疗人体中的药物滥用。方法：采用重叠和锥度方法将20例接受双相或精神分裂性情感障碍且当前滥用药物的抗精神病药物治疗患者改用开放标签阿立哌唑。在基线时，使用基于DSM-IV标准的Mini-International Neuropsychiatric Interview确认诊断。在12周内评估了精神症状，副作用，药物使用和渴望。用汉密尔顿抑郁量表（HAM-D），年轻躁狂量表（YMRS）和简短精神量表（BPRS）对精神病症状进行评估。使用视觉模拟量表评估物质渴望，并使用异常非自愿运动量表，Simpson-Angus量表，Barnes Akathisia量表和患者报告监测副作用。研究入组时间为2003年4月至2004年2月。结果：观察到HAM-D（p = .002），YMRS（p = .021）和BPRS（p = .000）得分从基线到出站的显着改善，而没有抗精神病药物引起的副作用量表的显着变化。在当前有酒精依赖的17位参与者中，发现在酒精上的花费（p = .042）和对酒精的渴望（p = .003）显着减少。在9名可卡因相关疾病参与者中，发现可卡因渴望显着降低（p = .014），但未使用。结论：阿立哌唑的改变与症状改善有关。该研究的局限性包括样本量小，损耗大和开放标签设计。需要在双重诊断患者中进行对照试验以确认这些发现。

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