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治疗耐药精神分裂症的非克洛沙干预措施:系统性审查和元分析
Richard Carr1,2,3, Alistair Cannon4,5, Valeria Finelli4,6
1Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK. richard.carr@kcl.ac.uk.
Molecular psychiatry
|October 3, 2025
概括
非克洛扎增强策略在治疗耐药精神分裂症 (TRS) 中表现有前途. 甘氨酸激动剂,非侵入性刺激,心理治疗和抗抑郁药在小型研究中改善了症状,但需要更多的研究来制定常规建议.
科学领域:
- 精神病学和药理学 精神病学和药理学
- 精神分裂症治疗研究研究
背景情况:
- 克洛扎是治疗耐药精神分裂症 (TRS) 的首要治疗方法.
- 当克洛沙平不可行或不能耐受时,需要采取替代干预措施.
- 本综述评估了TRS管理的非克洛沙平选择.
研究的目的:
- 系统地审查和元分析TRS非克洛扎宾干预措施的疗效.
- 评估对精神分裂症的正面,负面和总体症状的影响.
- 为了为TRS患者的临床决策提供信息,不适合克洛沙平.
主要方法:
- 78项研究的系统综述和元分析 (元分析中的68项,3241名患者).
- 在PsycInfo,PubMed和EMBASE数据库中搜索到2023年7月.
- 随机效应模型用于估计效应大小 (Hedges' g);用于质量评估的Cochrane偏差风险工具 (v2).
主要成果:
- 高剂量的抗精神病药物没有改善症状.
- 甘氨酸激动剂改善了积极,消极和总体症状 (低至非常低等级).
- 非侵入性刺激和心理治疗适度改善了积极症状 (低等级).
- 抗抑郁药物增强改善了负面和总症状 (非常低到低等级).
- 对于一些干预措施,发现了小样本大小和出版偏差.
结论:
- 一些非克洛沙平策略,包括药物治疗,非侵入性刺激和心理治疗,在小型研究中显示出好处.
- 目前没有任何干预措施达到作为克洛扎宾替代品的常规推的证据值.
- 高质量的临床试验对于制定TRS管理的最终建议至关重要.
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