높은 초조 또는 낮은 초조 증상을 경험하는 정신분열병 급성기 입원환자의 아리피프라졸 치료 효과
Aripiprazole Effects in Patients with Acute Schizophrenia Experiencing Higher or Lower Agitation
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초록
본 연구는 정신분열병 급성기 환자를 대상으로 아리피프라졸의 효과를 평가하고자 시행한 것으로, 초기 빠른 증량을 특징으로 하였다. 치료 전 초조의 정도에 상관없이 PANSS,PANSS-EC, GGI-S, GAF 모든 항목에서 치료 2주째부터(PANSS-EC는 치료 1주째부터) 유의한 호전을 보였으며, 8주간 지속적인 호전을 보였다. 또한 높은 초조군과 낮은 초조군 모두 PANSS-EC 총점이 유의한 감소를 보였다. 추체외로계 증상이 관찰되었지만 대부분 6주 이내에 소실되었으나, 경도의 경축의 경우 2명의 환자가 8주까지 어려움을 호소하였다. 추체외로계 증상 및 부작용으로 중도 탈락한 환자는 없었다. 반응군은 68.4%, 관해군은 47.4%로 현병력의 기간이 짧을수록 반응률과 관해율이 높았다. 본 연구의 결과는 추체외로계 증상에 유의하여 사용한다면 급성기 정신분열병에 아리피프라졸이 초조의 정도에 상관없이 효과적일 것이라는 것을 시사한다.
Abstract
Objectives: The purpose of this study was to investigate the efficacy and predictors of response to aripiprazole treatment in acute schizophrenic patients. We investigated whether baseline agitation level influences the treatment response, and examined the effects of oral aripiprazole in acute patients with schizophrenia experiencing either higher or lower levels of agitation. Methods: In this 8-week non-comparative clinical trial, 19 patients with a DSM-IV diagnosis of acute schizophrenia were enrolled. They were divided into groups experiencing higher or lower agitation at baseline. PANSS scores, CGI scores, GAF scores, and PANSS-EC score were used for efficacy assessments. Results: 63.2% of patients completed the study. The average dosage of aripiprazole was 26.2±4.8 mg. Treatment with aripiprazole resulted in significant improvement from baseline in all efficacy measures. In both the higher and lower groups, aripiprazole treatment produced significantly lower PANSS total and PANSS-EC scores, compare with baseline. Moreover, these significant improvements were sustained throughout a 8-week period. A shorter duration of the present episode is associated with a better clinical response. Extrapyramidal symptoms were observed in 36.8% of patients; however, the side effects did not influence the treatment response. Conclusion: High doses of aripiprazole significantly improved acute symptoms of schizophrenia irrespective to baseline agitation level, without any significant adverse event. These results suggest that aripiprazole is an effective and safe treatment option for patients with acute schizophrenia who manifest agitation symptoms.
참고문헌 (27)
- Cassens G, "Neuroleptics: effects on neuropsychological function in chronic schizophrenic patients", Schizophr Bull, 16, pp.477~499 (1990)
- Kapur S, "Half a century of antipsychotics and still a central role for dopamine D2 receptors", Prog Neuropsychopharmacol Biol Psychiatry, 27, pp.1081~1090 (2003)
- Tschoner A, "Metabolic side effects of antipsychotic medication", Int J Clin Pract, 61, pp.1356~1370 (2007)
- Burris KD, "Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors", J Pharmacol Exp Ther, 302, pp.381~389 (2002)
- butyloxy}-3,4-dihydro -2(1H)-quinolinone (OPC-14597) on prolactin release from the rat anterior pituitary gland, "J Pharmacol Exp Ther", 1996, 137~143
- DeLeon A, "Aripiprazole: a comprehensive review of its pharmacology, clinical efficacy, and tolerability", Clin Ther, 26, pp.649~666 (2004)
- Carson WH, "A double-blind, placebo-controlled trial of aripiprazole and haloperidol", Schizophr Res, 49, pp.221~222 (2001)
- Yeung PP, "Efficacy of aripiprazole, a novel antipsychotic, in schizophrenia and schizoaffective disorder: results of a placebo-controlled trial with risperidone", Eur Neuropsychopharmacol, 11(3), pp.S259~S260 (2001)
- "Neurocognitive benefits of aripiprazole versus olanzapine in stable psychosis", Eur Neuropsychopharmacol, 12(3), pp.S291~ (2002)
- Kane JM, "Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder", J Clin Psychiatry, 63, pp.763~771 (2002)
- Ramaswamy S, "Aripiprazole possibly worsens psychosis", Int Clin Psychoparmacol, 19, pp.45~48 (2004)
- Fleischhacker WW, "Aripiprazole", Expert Opin Pharmacother, 6, pp.2091~2101 (2005)
- Kinghorn WA, "Aripiprazole: pharmacology, efficacy, safety and tolerability", Expert Rev Neurother, 5, pp.297~307 (2005)
- Potkin SG, "Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs. placebo in patients with schizophrenia and schizoaffective disorder", Arch Gen Psychiatry, 60, pp.681~690 (2003)
- Chan HY, "Efficacy and safety of aripiprazole in the acute treatment of schizophrenia in Chinese patients with risperidone as an active control: a randomized trial", J Clin Psychiatry, 68, pp.29~36 (2007)
- Marder SR, "Aripiprazole effects in patients with acute schizophrenia experiencing higher or lower agitation: a post hoc analysis of 4 randomized, placebo-controlled clinical trials", J Clin Psychiatry, 68, pp.662~668 (2007)
- Kasper S, "Efficacy and safety of aripiprazole vs. haloperidol for long-term maintenance treatment following acute relapse of schizophrenia", Int J Neuropsychopharmacol, 6, pp.325~337 (2003)
- Perkins D, "Predictors of antipsychotic treatment response in patients with firstepisode schizophrenia, schizoaffective and schizophreniform disorders", Br J Psychiatry, 185, pp.18~24 (2004)
- Wright P, "Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia", Am J Psychiatry, 158, pp.1149~1151 (2001)
- Breier A, "A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia", Arch Gen Psychiatry, 59, pp.441~448 (2002)
- Kinon BJ, "Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia", Am J Emerg Med, 22, pp.181~186 (2004)
- Kinon BJ, "Olanzapine versus aripiprazole for the treatment of agitation in acutely ill patients with schizophrenia", J Clin Psychoparmacol, 28, pp.601~607 (2008)
- Lieberman J, "Meta-analysis of the efficacy of aripiprazole in schizophrenia", Int J Neuropsychopharmacol, 5, pp.S186~ (2002)
- Robinson DG, "Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder", Am J Psychiatry, 156, pp.544~549 (1999)
- Garver DL, "Heterogeneity of response to antipsychotics from multiple disorders in the schizophrenia spectrum", J Clin Psychiatry, 61, pp.964~972 (2000)
- Taylor D, "A prospective 6-month analysis of the naturalistic use of aripiprazole-factors predicting favourable outcome", Acta Psychiatr Scand, 116, pp.461~466 (2007)
- Marder SR, "Aripiprazole in the treatment of schizophrenia: safety and tolerability in short-term, placebo-controlled trials", Schizophr Res, 61, pp.123~136 (2003)