| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 85 === AbstractAntipsychotics are currently most widely used and
effective treatment for schizophrenia. Since its application
clinically, psychiatric admission has been reducing
dramatically, leading to reduction of health budget as well as
possibility for patient to return to family and community.
However, the extrapyramidal system side effects (EPS) resulted
from blockade of striatal dopamine receptor may often appear
simultaneously with the antipsychotic effect. Anticholinergics
can be used in the treatment of EPS or prevention from their
appearance, with a possibility of enhancing anticholinergic side
effects of anitpsyhcotics. Though it has generally been believed
that anticholinergic is indicated for prevention of EPS in high
risk group, the concomitant use of anticholinergic for
prevention of EPS has been hitherto a controversial issue since
the development of chlorpromazine in 1950s.This study consists
of two separated parts. Firstly a retrospective survey was
carried out to investigate the prescription behaviour when using
anticholinergic and antipsychotics for treatment of
schizophrenia through review of medical record. The second part
was a randomized double-blind placebo-controlled clinical trial
to examine the efficacy of trihexyphenidyl, an anticholinergics
for prevention of EPS induced by haloperidol.229 admissions of
schizophrenic patient in 19 months, from January 1995 to July
1996, were included in the analysis of the first study. The
result showed that in 82.5% of the total index admissions
anticholinergics was prescribed in combination with
antipsychotics initially. Drug induced parkinsonism (19.2%) was
the most common EPS, followed by acute dystonia (14.4%) and
akathisia (14.0%). On the other hand, constipation (30.6%) was
the most common anticholinergic side effects noted, followed by
urine stasis and reduced urine stream (12.2%) , palpitation
(5.2%) , blurred vision (2.2%) and dry mouth (1.3%).Regarding
placebo-controlled drug trial, 51 psychiatric inpatients with
schizophrenia participated in the study. Twenty-seven cases
administered haloperidol with trihexyphenidyl, remained 24 with
placebo . Two out of 27 cases of trihexyphenidyl group, compared
to 7 out of 24 placebo group, developed acute dystonia within 14
days of the treatment period ((2=6.80, p=0.009). No significant
differences were found between two groups on the other types of
EPS and anticholinergic side effects. The study results suggest
that trihexyphenidyl (Artane() is able to reduced the
development of acute dystonia significantly .
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