정신분열병에서 이세대 항정신병약물의 효과
Efficacy of Second Generation Antipsychotics in Schizophrenia
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Clozapine 치료 중 haloperidol이나 chlopromazine에 비하여 추체외로증상 발현이 낮았으며, chlorproma-zine에 비하여 기립성 저혈압의 발현도 낮다. 그러나 백혈구 과립구저하와 무과립구증이 빈도는 낮으나 치명적일 수 있음으로 주의를 요한다. Clozapine 치료 중 과립구저하와 무과립구증의 빈도가 각 2.9%와 0.8%로 다른 항정신병약물에 비하여 높다.37)Clozapine 치료중 환자가 흔히 호소하고 불편해 하는 부작용은 침 과다분비와 체중 증가이다. 항정신병약물에 흔히 나타나는 졸림증은 chlorpromazine이나 haloperidol과 비슷한 빈도로 나타난다. Risperi done은 위약과 비교하여 추체외로증상과 함께 졸림증, 두통, 어지름증, 위장애 등의 빈도가 높다고 보고되었다. Risperidone은 ha -lopeidol 치료군과 비교하여 일일 6mg이하에서는 추체외로증상의 빈도는 낮았으나 일일 16mg이상에서는 ha-loperidol 군과 차이가 없었다. Risperidone도 체중 증가와 prolactin 분비 증가가 나타난다. Olanzapine은 ha -loperidol과 비교하여 추체외로증상의 발현이 낮다. 그러나 olanzapine 군에서 체중증가가 높았으며 비록 임상적으로 문제가 되지 않으나 간 효소의 증가가 있었다. 그러나 prolactin의 증가 정도는 위약군과 차이가 없었－ 123 － 으며 haloperidol 군보다 유의하게 낮았다. Quetiapine은 두통, 변비 소회장애가 위약군보다 2배 정도 높게 나타났다. Haloperidol 군과 비 교하여 추체외로증상의 발현이 유의하게 낮았으며, pro lactin은 유의하게 감소하였으나, 체중증가는 haloperidol에서 보다 높았으며, 간 효소가 증가되었다. Amisulpride는 hal operidol에 비하여 추체외로증상의 빈도는 낮았으나 체중증가 정도가 높아 장기 치료시 5%이상 체중 증가 비율이 30%로 보고되었다. Amisulpride는 치료 초기 prolactin 혈중 농도를 3~4배 증가시키며 치료 1년 후 1.5배 증가되었으며, 2%에서 간 효소가 증가되었다. Aripiprazole은 haloperidol에 비하여 추체외로증상의 빈도가 낮으며 prolactin은 증가되지 않았으며 체중증가도 위약군과 차이가 없었다. Ziprasidone은 위약에 비교하여 졸림과 좌불안증의 빈도가 높았으며 다른 부작용의 빈도는 차이가 없었다. 다른 항정신병약물으로 부터 ziprasi-done으로 바뀐 경우에 추체외로증상은 현저하게 줄었으며 체중도 줄어 치료중 체중증가는 없었다. 그러나 zip-rasidone은 QTc 간격을 증가시켜 주의를 요한다.
Abstract
Following the introduction of clozapine, a series of new antipsychotics have been introduced for the treatment of schizophrenia. These new antipsychotics share common clinical profiles, i.e. better efficacy on negative symptoms, less extrapyramydal side effects, and less effect on prolactin. Currently clozapine, risperidone, olanzapine, quetiapine, amisulpride, aripiprazole, and ziprasidone are available in Korea (in order of introduction in Korea). This paper reviewed the major efficacy studies of these second generation antipsychotics(SGAs). Although SGAs as group are superior to the first generation antipsychotics in their efficacy and side effects, optimizing treatment requires choosing appropriate antipsychotics to match the diverse needs of schizophrenic patients.
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