帕罗西汀联合小剂量非典型抗精神病药物治疗老年期和非老年期广泛性焦虑障碍的疗效对比分析
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摘要
目的:比较帕罗西汀联合小剂量非典型抗精神病药物治疗老年期和非老年期广泛性焦虑障碍的疗效、安全性差异。方法:选取2017.1.1-2018.11.15日于西南医科大学附属医院精神科住院的满足ICD-10广泛性焦虑障碍诊断标准的患者188例,据年龄分成老年组(年龄大于等于60岁)和非老年组(年龄小于60岁),老年组和非老年组均随机分为实验组和对照组,实验组给予帕罗西汀联合非典型抗精神病药物(包括奥氮平片、富马酸喹硫平片)治疗,对照组仅给予帕罗西汀治疗,分别于治疗前和治疗后2周使用汉密尔顿焦虑量表(HAMA)评估临床疗效,个人与社会表现量表(PSP)评估社会功能,药物不良反应量表(UKU)、胃肠道症状评定量表(GSRS)评定不良反应。结果:(1)治疗前HAMA、PSP得分比较:老年和非老年的实验组、对照组治疗前HAMA、PSP评分均无统计学差异(P> 0.05),老年实验组和非老年实验组HAMA、PSP评分无统计学差异(P> 0.05),老年对照组和非老年对照组HAMA、PSP评分无统计学差异(P> 0.05);(2)治疗2周后与治疗前HAMA、PSP对比:老年、非老年实验组均较对照组HAMA减分率更高、PSP加分率更高(P <0.05),非老年实验组较老年实验组HAMA减分率高、PSP加分率更高(P <0.05);(3)治疗2周后药物副作用结果:老年、非老年实验组副作用发生率较对照组无差异(P> 0.05),老年实验组较非老年实验组副作用发生率无差异(P> 0.05),老年对照组较非老年对照组无差异(P> 0.05)。结论:老年组和非老年组帕罗西汀联用非典型抗精神病药物的疗效均较单用帕罗西汀更好,社会功能恢复更好,帕罗西汀联用非典型抗精神病药物治疗非老年期广泛性焦虑障碍较老年期广泛性焦虑障碍疗效更好,社会功能恢复更好,副反应发生率无显著差异。
Objective: To compare the efficacy and safety of paroxetine tablets combined with low-dose atypical antipsychotic drugs in the treatment of generalized anxiety disorder in the elderly and non-elderly individuals.Methods: The 188 patients who met the diagnostic criteria of generalized anxiety disorder according to ICD-10 were selected from the psychiatric department of the Affiliated Hospital of Southwest Medical University from January 1,2017 to November 15,2018.The participants were divided into the elderly group( older than 60 years old) and the non-elderly group( younger than 60 years old).The elderly group and the non-elderly group were randomly divided into the experimental group and the control group.The experimental group was given paroxetine tablets combined with atypical antipsychotic drugs( including olanzapine and quetiapine fumarate).The control group was treated with paroxetine alone.The clinical efficacy was assessed by Hamilton Anxiety Scale( HAMA) before and 2 weeks after treatment.The social function was assessed by Personal and Social Performance Scale( PSP).The adverse reactions and gastrointestinal symptoms were assessed by UKU and GSRS scale,respectively.Results:( 1) There was no statistical difference in HAMA and PSP scores among these groups before treatment( P > 0.05);( 2) After 2 weeks of treatment,the HAMA reduction rate and PSP increase rate of the elderly and non-elderly experimental group were higher than those of control group( P < 0.05),and the HAMA reduction rate and PSP increase rate of the non-elderly experimental group were higher than those of elderly experimental group( P < 0.05);( 3) The side effects of drugs after 2 weeks of treatment: there was no difference in the incidence of side effects among all these groups( P >0.05).Conclusion: The effect of paroxetine combined with atypical antipsychotics in elderly and non-elderly groups was better than that of paroxetine alone,and the recovery of social function was also better in combination group.In addition,the effect of paroxetine combined with atypical antipsychotics in non-elderly patients with generalized anxiety disorder was better than that in elderly patients,and the recovery of social function was also better.There was no significant difference in the incidence of side effects between groups.
Objective: To compare the efficacy and safety of paroxetine tablets combined with low-dose atypical antipsychotic drugs in the treatment of generalized anxiety disorder in the elderly and non-elderly individuals.Methods: The 188 patients who met the diagnostic criteria of generalized anxiety disorder according to ICD-10 were selected from the psychiatric department of the Affiliated Hospital of Southwest Medical University from January 1,2017 to November 15,2018.The participants were divided into the elderly group( older than 60 years old) and the non-elderly group( younger than 60 years old).The elderly group and the non-elderly group were randomly divided into the experimental group and the control group.The experimental group was given paroxetine tablets combined with atypical antipsychotic drugs( including olanzapine and quetiapine fumarate).The control group was treated with paroxetine alone.The clinical efficacy was assessed by Hamilton Anxiety Scale( HAMA) before and 2 weeks after treatment.The social function was assessed by Personal and Social Performance Scale( PSP).The adverse reactions and gastrointestinal symptoms were assessed by UKU and GSRS scale,respectively.Results:( 1) There was no statistical difference in HAMA and PSP scores among these groups before treatment( P > 0.05);( 2) After 2 weeks of treatment,the HAMA reduction rate and PSP increase rate of the elderly and non-elderly experimental group were higher than those of control group( P < 0.05),and the HAMA reduction rate and PSP increase rate of the non-elderly experimental group were higher than those of elderly experimental group( P < 0.05);( 3) The side effects of drugs after 2 weeks of treatment: there was no difference in the incidence of side effects among all these groups( P >0.05).Conclusion: The effect of paroxetine combined with atypical antipsychotics in elderly and non-elderly groups was better than that of paroxetine alone,and the recovery of social function was also better in combination group.In addition,the effect of paroxetine combined with atypical antipsychotics in non-elderly patients with generalized anxiety disorder was better than that in elderly patients,and the recovery of social function was also better.There was no significant difference in the incidence of side effects between groups.
引文
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[24]曹天忠.帕罗西汀联合小剂量非典型抗精神病药物或单用帕罗西汀治疗老年抑郁症的疗效和安全性[J].中国医药指南,2016,14(23):119.
[25]朱培俊,唐琳,杨国平.草酸艾司西酞普兰联合小剂量奥氮平治疗抑郁症的疗效与安全性观察[J].贵州医药,2018,42(8):987-988.
[26]董尚萍.奥氮平联合艾司西酞普兰对抑郁症患者抑郁症状及睡眠质量的影响[J].临床合理用药杂志,2018,11(26):7-8.
[27]孙学勇,刘莉莉.奥氮平对伴有焦虑的抑郁症的治疗作用分析[J].中国现代药物应用,2016,10(12):124-125.
[28]Simon NM,Connor KM,Le Beau RT,et al.,Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder:preliminary findings[J].Psychopharmacology(Berl),2008,197(4):675-681.
[29]乔颖,何燕玲,赵靖平,等,个体和社会功能量表信效度研究[J].中国医药导报,2012,9(26):11-14.
[30]Chen KP,Lung FW.Reliability and validity of the short version of udvalg for kliniske undersogelser in antipsychotic treatment[J].Psychiatr Q,2017,88(4):787-796.
[31]Wiklund IK,Fullerton S,Hawkey CJ,et al.An irritable bowel syndrome-specific symptom questionnaire:development and validation[J].Scand J Gastroenterol,2003,38(9):947-954.
[2]Wittchen HU.Generalized anxiety disorder:prevalence,burden,and cost to society[J].Depress Anxiety,2002,16(4):162-71.
[3]Wehry AM,Beesdo-Baum K,Hennelly MM,et al.Assessment and treatment of anxiety disorders in children and adolescents[J].Curr Psychiatry Rep,2015,17(7):52.
[4]黎柱培,帕罗西汀联合小剂量非典型抗精神病药物在老年抑郁症患者中应用效果研究[J].中国医药科学,2012,2(14):42-43.
[5]张繁新.老年期与非老年期焦虑症临床对照研究[J].中国民康医学,2008,23:2737-2738.
[6]吕永宾.老年期与非老年期焦虑症临床对照分析[J].中国处方药,2015,13(3):115.
[7]Bandelow B,Zohar J,Hollander E,et al.World Federation of societies of biological psychiatry(WFSBP)guidelines for the pharmacological treatment of anxiety,obsessive-compulsive and posttraumatic stress disorders[J].World J Biol Psychiatry,2002,3(4):171-199.
[8]Klerman GL,Weissman MM,Ouellette R,Johnson J,et al.Panic attacks in the community.Social morbidity and health care utilization[J].JAMA,1991,265(6):742-746.
[9]Bradwejn J.Benzodiazepines for the treatment of panic disorder and generalized anxiety disorder:clinical issues and future directions[J].Can J Psychiatry,1993,38(4):109-113.
[10]Nutt D,Argyropoulos S,Hood S,et al.Generalized anxiety disorder:A comorbid disease[J].Eur Neuropsychopharmacol,2006,16(2):109-118.
[11]Cisneros GE,Ausin B.Prevalence of anxiety disorders in people over 65 years-old:A systematic review[J].Rev Esp Geriatr Gerontol,2019,54(1):34-48.
[12]Katzman MA,Brawman-Mintzer O,Reyes EB,et al.Extended release quetiapine fumarate(quetiapine XR)monotherapy as maintenance treatment for generalized anxiety disorder:a long-term,randomized,placebo-controlled trial[J].Int Clin Psychopharmacol,2011,26(1):11-24.
[13]Katzman MA.Aripiprazole:a clinical review of its use for the treatment of anxiety disorders and anxiety as a comorbidity in mental illness[J].J Affect Disord,2011,128(1):11-20.
[14]Sepede G,Gambi F,Onofrj M,et al.Olanzapine enhances anxiety response to an SSRI in a woman with bipolar disorder[J].Prog Neuropsychopharmacol Biol Psychiatry,2011,35(1):303-304.
[15]Simon NM,Connor KM,Le Beau RT,et al.Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder:preliminary findings[J].Psychopharmacology(Berl),2008,197(4):675-681.
[16]Worboys M.The Hamilton Rating Scale for Depression:The making of a"gold standard"and the unmaking of a chronic illness,1960-1980[J].Chronic Illn,2013,9(3):202-219.
[17]Tianmei S,Liang S,Yun'ai S,et al.The Chinese version of the Personal and Social Performance Scale(PSP):validity and reliability[J].Psychiatry Res,2011,185(1-2):275-279.
[18]张明园,何燕玲.精神科评定量表手册[J].长沙:湖南科学技术出版社,2016,428-440.
[19]Jensen NH,Rodriguiz RM,Caron MG,et al.N-desalkylquetiapine,a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist,as a putative mediator of quetiapine's antidepressant activity[J].Neuropsychopharmacology,2008,33(10):2303-2312.
[20]Pollack MH,Zaninelli R,Goddard A,et al.Paroxetine in the treatment of generalized anxiety disorder:results of a placebocontrolled,flexible-dosage trial[J].J Clin Psychiatry,2001,62(5):350-357.
[21]Buoli M,Caldiroli A,Caletti E,et al.New approaches to the pharmacological management of generalized anxiety disorder[J].Expert Opin Pharmacother,2013,14(2):175-184.
[22]Pollack MH,Simon NM,Zalta AK,et al.Olanzapine augmentation of fluoxetine for refractory generalized anxiety disorder:a placebo controlled study[J].Biol Psychiatry,2006,59(3):211-215.
[23]Stern RG,Petti TA,Bopp K,et al.Aripiprazole for the treatment of schizophrenia with co-occurring social anxiety:an openlabel cross-taper study[J].J Clin Psychopharmacol,2009,29(3):206-209.
[24]曹天忠.帕罗西汀联合小剂量非典型抗精神病药物或单用帕罗西汀治疗老年抑郁症的疗效和安全性[J].中国医药指南,2016,14(23):119.
[25]朱培俊,唐琳,杨国平.草酸艾司西酞普兰联合小剂量奥氮平治疗抑郁症的疗效与安全性观察[J].贵州医药,2018,42(8):987-988.
[26]董尚萍.奥氮平联合艾司西酞普兰对抑郁症患者抑郁症状及睡眠质量的影响[J].临床合理用药杂志,2018,11(26):7-8.
[27]孙学勇,刘莉莉.奥氮平对伴有焦虑的抑郁症的治疗作用分析[J].中国现代药物应用,2016,10(12):124-125.
[28]Simon NM,Connor KM,Le Beau RT,et al.,Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder:preliminary findings[J].Psychopharmacology(Berl),2008,197(4):675-681.
[29]乔颖,何燕玲,赵靖平,等,个体和社会功能量表信效度研究[J].中国医药导报,2012,9(26):11-14.
[30]Chen KP,Lung FW.Reliability and validity of the short version of udvalg for kliniske undersogelser in antipsychotic treatment[J].Psychiatr Q,2017,88(4):787-796.
[31]Wiklund IK,Fullerton S,Hawkey CJ,et al.An irritable bowel syndrome-specific symptom questionnaire:development and validation[J].Scand J Gastroenterol,2003,38(9):947-954.