女性精神分裂症谱系障碍药物治疗的循证建议。

IF 5.5 2区 医学 Q1 PSYCHIATRY
Current Psychiatry Reports Pub Date : 2023-11-01 Epub Date: 2023-10-21 DOI:10.1007/s11920-023-01460-6
Bodyl A Brand, Elske J M Willemse, Iris M H Hamers, Iris E Sommer
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引用次数: 0

摘要

综述目的:尽管有明确证据表明性别差异在很大程度上影响抗精神病药物的疗效和耐受性,但目前精神分裂症谱系障碍(SSD)的治疗指南并没有区分男性和女性。这篇综述总结了可能改善女性药物治疗的策略的现有证据,并为优化女性精神分裂症的治疗提供了循证建议。最近的发现:我们系统地在PubMed和Embase上搜索了三个主题的同行评审研究:(1)剂量调整的抗精神病药物血清浓度的性别差异,(2)用雌激素和雌激素样化合物进行激素增强治疗以改善症状严重程度,以及(3)减少抗精神病药诱导的高泌乳素血症的策略。基于三项数据库研究和一项随机对照试验,我们发现大多数抗精神病药物在女性中的剂量调整浓度高于男性。奎硫平的浓度更高,尤其是在老年妇女中。根据最近的两项荟萃分析,雌激素和雷洛昔芬都改善了整体症状。在绝经后妇女中发现雷洛昔芬增强的结果最为一致。没有研究评估雌激素避孕药对症状的影响。根据两项荟萃分析和一项随机对照试验,辅助阿立哌唑是降低抗精神病药物诱导的高泌乳素血症的最佳研究和最安全的策略。SSD女性特异性药物治疗的循证建议包括:(1)抗精神病药物的女性特异性给药(以治疗药物监测为指导),(2)绝经后女性用雷洛昔芬进行激素替代,以及(3)在抗精神病药诱导的高泌乳素血症的情况下,添加阿立哌唑作为最佳证据。结合这些策略可以减少SSD妇女的副作用并改善其预后,这一点应在未来的纵向随机对照试验中得到证实。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders.

Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders.

Purpose of review: Despite clear evidence that sex differences largely impact the efficacy and tolerability of antipsychotic medication, current treatment guidelines for schizophrenia spectrum disorders (SSD) do not differentiate between men and women. This review summarizes the available evidence on strategies that may improve pharmacotherapy for women and provides evidence-based recommendations to optimize treatment for women with schizophrenia.

Recent findings: We systematically searched PubMed and Embase for peer-reviewed studies on three topics: (1) sex differences in dose-adjusted antipsychotic serum concentrations, (2) hormonal augmentation therapy with estrogen and estrogen-like compounds to improve symptom severity, and (3) strategies to reduce antipsychotic-induced hyperprolactinemia. Based on three database studies and one RCT, we found higher dose-adjusted concentrations in women compared to men for most antipsychotics. For quetiapine, higher concentrations were specifically found in older women. Based on two recent meta-analyses, both estrogen and raloxifene improved overall symptomatology. Most consistent findings were found for raloxifene augmentation in postmenopausal women. No studies evaluated the effects of estrogenic contraceptives on symptoms. Based on two meta-analyses and one RCT, adjunctive aripiprazole was the best-studied and safest strategy for lowering antipsychotic-induced hyperprolactinemia. Evidence-based recommendations for female-specific pharmacotherapy for SSD consist of (1) female-specific dosing for antipsychotics (guided by therapeutic drug monitoring), (2) hormonal replacement with raloxifene in postmenopausal women, and (3) aripiprazole addition as best evidenced option in case of antipsychotic-induced hyperprolactinemia. Combining these strategies could reduce side effects and improve outcome of women with SSD, which should be confirmed in future longitudinal RCTs.

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来源期刊
CiteScore
11.30
自引率
3.00%
发文量
68
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published research in psychiatry. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by psychiatric disorders. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anxiety, medicopsychiatric disorders, and schizophrenia and other related psychotic disorders. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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