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Impact of long-acting injectable aripiprazole on the concomitant medication and antipsychotic polypharmacy: a retrospective, observational study of 127 patients with psychosis. 长效注射阿立哌唑对伴随用药和抗精神病药物的影响:对127例精神病患者的回顾性观察研究。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2023-11-20 DOI: 10.1097/YIC.0000000000000492
Junhee Lee, Sanghoon Oh, Sun-Young Moon, Silvia Kyungjin Loh, Minah Kim, Tae Young Lee, Jun Soo Kwon

Antipsychotic polypharmacy (APP) has become prevalent over the years, but several concerns have been raised over APP. Accumulating evidence suggests that aripiprazole long-acting injectable (LAI) may reduce the rate of APP, but the association remains speculative. This retrospective observational study included 127 patients with psychosis and observed them for 1.8 ± 1.3 years, up to 4 years. Prescription data of antipsychotics (APs), mood stabilisers, benzodiazepines, and anti-extrapyramidal side effect medications were obtained at baseline and the last observation. Daily chlorpromazine equivalent (CPZ) dose of APs decreased from 124.40 ± 235.35 mg to 77.95 ± 210.36 mg ( P = 0.027). The daily dose of anticholinergics and beta-blockers also significantly decreased after introducing aripiprazole LAI. Among the patients having APP, the number of concurrent APs along with daily CPZ dose of APs decreased after initiation of aripiprazole LAI from 1.28 ± 0.62 to 0.85 ± 0.73 ( P < 0.001) and 298.33 ± 308.70 mg to 155.43 ± 280.53 mg ( P = 0.004), respectively. Treatment with aripiprazole LAI for up to 4 years in patients with psychosis was associated with a reduced number of prescribed APs in patients having an APP and a reduced dose of APs and concurrent psychotropic medications.

抗精神病药物综合用药(APP)近年来越来越普遍,但也引起了一些关注。越来越多的证据表明,阿立哌唑长效注射(LAI)可能会降低APP的发生率,但两者之间的联系仍是推测性的。回顾性观察研究纳入127例精神病患者,观察时间1.8±1.3年,最长4年。获得基线和末次观察时抗精神病药物(APs)、情绪稳定剂、苯二氮卓类药物和抗锥体外系副作用药物的处方数据。每日氯丙嗪当量(CPZ)剂量由124.40±235.35 mg降至77.95±210.36 mg (P = 0.027)。阿立哌唑LAI后抗胆碱能药物和受体阻滞剂的日剂量也显著降低。在APP患者中,阿立哌唑LAI起始后并发ap数和ap日CPZ剂量分别从1.28±0.62 mg降至0.85±0.73 mg (P < 0.001)和298.33±308.70 mg降至155.43±280.53 mg (P = 0.004)。精神病患者使用阿立哌唑LAI治疗长达4年,与APP患者处方APs数量减少、APs剂量减少以及同时使用精神药物相关。
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引用次数: 0
Recent updates on treatment patterns in patients with treated attention-deficit/hyperactivity disorders from a nationwide real-world database in South Korea. 从韩国全国范围的真实世界数据库中了解治疗注意力缺陷/多动障碍患者的最新治疗模式。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2024-03-11 DOI: 10.1097/YIC.0000000000000549
Yoon Cho, Ah-Young Kim, Sukhyang Lee, Hankil Lee

The prevalence of attention-deficit/hyperactivity disorder (ADHD) is steadily increasing across Korea. We analyzed ADHD patients with ADHD medications (Rx) characteristics and treatment patterns compared to patients without Rx and identified the differences between pediatric-/adult- and active-/transient-patients with Rx. Using a nationwide claims dataset from 2020 to 2021, we conducted a prevalence-based cross-sectional study and analyzed the recent patients' characteristics and patterns among ADHD patients. Among 132 017 ADHD patients with Rx, differences from 20 312 without Rx across all characteristics except sex. We found significant differences in characteristics and treatment patterns between pediatric-/adult- and active-/transient-patients with Rx. Age-specific sex ratios notably diverged in pediatric patients (61.2%), but remained similar in adults, revealing significant psychiatric comorbidities differences. Active-patients peaked at 6-11 years (41.4%), while transient-patients at 18-30 years (36.1%). Predominantly, methylphenidate (89.7%), atomoxetine (27.8%), and clonidine (2.8%) were prescribed, with 85% experiencing treatment changes within methylphenidate formulations. In pediatric patients, extended-release methylphenidate was preferred (56.1%), adults favored oral delivery system methylphenidate (71.5%), and active-patients had higher treatment rates than transient-patients across all patterns, with low monotherapy rates. This study provides epidemiologic insights into recent characteristics and treatment patterns of ADHD patients with Rx in Korea, providing valuable evidence for identifying those actively receiving ADHD treatment in future healthcare policy decisions.

在韩国,注意力缺陷/多动障碍(ADHD)的发病率正在稳步上升。我们分析了服用多动症药物(Rx)的多动症患者与未服用Rx的患者的特征和治疗模式,并确定了服用Rx的儿童/成人患者与活动性/暂时性患者之间的差异。我们利用 2020 年至 2021 年的全国报销数据集,开展了一项基于患病率的横断面研究,分析了多动症患者的近期特征和模式。在 132 017 名有药物治疗的多动症患者中,除性别外,其他特征均与 20 312 名无药物治疗的患者存在差异。我们发现,有药物治疗的儿童/成人患者和活动期/暂时性患者在特征和治疗模式上存在明显差异。儿科患者的特定年龄性别比例明显不同(61.2%),但在成人中却保持相似,这揭示了显著的精神疾病合并症差异。活跃期患者在 6-11 岁达到高峰(41.4%),而短暂期患者在 18-30 岁达到高峰(36.1%)。处方药物主要是哌醋甲酯(89.7%)、阿托西汀(27.8%)和氯尼丁(2.8%),其中 85% 的患者更换了哌醋甲酯的治疗方案。儿童患者首选缓释哌醋甲酯(56.1%),成人患者首选口服给药系统哌醋甲酯(71.5%),在所有模式中,活动期患者的治疗率均高于短暂性患者,单药治疗率较低。这项研究从流行病学角度揭示了韩国ADHD患者的近期特征和药物治疗模式,为在未来的医疗保健政策决策中识别那些积极接受ADHD治疗的患者提供了宝贵的证据。
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引用次数: 0
Case report and systematic review of cerebellar vermis alterations in psychosis. 精神病患者小脑蚓部改变的病例报告和系统回顾。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2024-02-13 DOI: 10.1097/YIC.0000000000000535
Nicola Dusi, Cecilia Maria Esposito, Giuseppe Delvecchio, Cecilia Prunas, Paolo Brambilla

Introduction: Cerebellar alterations, including both volumetric changes in the cerebellar vermis and dysfunctions of the corticocerebellar connections, have been documented in psychotic disorders. Starting from the clinical observation of a bipolar patient with cerebellar hypoplasia, the purpose of this review is to summarize the data in the literature about the association between hypoplasia of the cerebellar vermis and psychotic disorders [schizophrenia (SCZ) and bipolar disorder (BD)].

Methods: A bibliographic search on PubMed has been conducted, and 18 articles were finally included in the review: five used patients with BD, 12 patients with SCZ and one subject at psychotic risk.

Results: For SCZ patients and subjects at psychotic risk, the results of most of the reviewed studies seem to suggest a gray matter volume reduction coupled with an increase in white matter volumes in the cerebellar vermis, compared to healthy controls. Instead, the results of the studies on BD patients are more heterogeneous with evidence showing a reduction, no difference or even an increase in cerebellar vermis volume compared to healthy controls.

Conclusions: From the results of the reviewed studies, a possible correlation emerged between cerebellar vermis hypoplasia and psychotic disorders, especially SCZ, ultimately supporting the hypothesis of psychotic disorders as neurodevelopmental disorders.

导言:精神病患者的小脑改变,包括小脑蚓部的体积变化和皮质小脑连接的功能障碍,均有文献记载。本综述从一名患有小脑发育不全的双相情感障碍患者的临床观察出发,旨在总结有关小脑蚓部发育不全与精神障碍(精神分裂症(SCZ)和双相情感障碍(BD))之间关系的文献数据:方法:在PubMed上进行文献检索,最终有18篇文章被纳入综述:其中5篇使用了BD患者的数据,12篇使用了SCZ患者的数据,1篇使用了有精神病风险的受试者的数据:对于严重自闭症患者和有精神病风险的受试者,与健康对照组相比,大多数综述研究的结果似乎都表明小脑蚓部灰质体积缩小,白质体积增大。相反,对 BD 患者的研究结果则较为不一,有证据显示,与健康对照组相比,小脑蚓部体积缩小、无差异甚至增大:从综述的研究结果来看,小脑蚓部发育不全与精神障碍,尤其是SCZ之间可能存在相关性,最终支持了精神障碍是神经发育障碍的假设。
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引用次数: 0
Focus on neurodevelopmental conditions and antipsychotics prescription patterns. 重点关注神经发育状况和抗精神病药物处方模式。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2024-05-29 DOI: 10.1097/YIC.0000000000000555
Alessandro Serretti
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引用次数: 0
Sociodemographic and clinical factors associated with prescription of first- versus second-generation long-acting antipsychotics in incarcerated adult males. 在被监禁的成年男性中,与第一代和第二代长效抗精神病药物处方相关的社会形态和临床因素。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2023-10-02 DOI: 10.1097/YIC.0000000000000516
Enrico Capuzzi, Carla Laura Di Forti, Alice Caldiroli, Francesca Cova, Teresa Surace, Massimiliano Buoli, Massimo Clerici

Information on patterns of prescription of long-acting injection (LAI) antipsychotics among people who are incarcerated is lacking. Therefore, we aimed to evaluate prescribing rates for first-generation antipsychotic (FGA)-LAI versus second-generation antipsychotic (SGA)-LAI and to identify the factors associated with the prescription of one of the two classes of LAI. A cross-sectional study was conducted among incarcerated adult males hosted in Monza detention center between January 2013 and April 2023. Socio-demographic and clinical data were retrospectively collected. Descriptive and univariate statistics as well as logistic regression analyses were performed. Data were available for 135 consecutive incarcerated adult males with different mental disorders who received a LAI as part of their treatment. 75.6% of our sample was treated with FGA-LAIs, with haloperidol as the most commonly prescribed drug, followed by zuclopentixol and aripiprazole. Diagnosis of bipolar disorder and concomitant administration of antidepressants were statistically significant predictors of SGA-LAI prescription. Some patients' characteristics may influence prescription patterns in prison. Further longitudinal studies with larger samples should confirm these findings.

缺乏关于被监禁者中长效注射(LAI)抗精神病药物处方模式的信息。因此,我们旨在评估第一代抗精神病药物(FGA)-LAI与第二代抗精神疾病药物(SGA)-LAI的处方率,并确定与两类LAI之一的处方相关的因素。2013年1月至2023年4月,在蒙扎拘留中心收容的被监禁成年男性中进行了一项横断面研究。回顾性收集社会人口学和临床数据。进行描述性和单变量统计以及逻辑回归分析。有135名患有不同精神障碍的连续监禁成年男性的数据,他们接受了LAI作为治疗的一部分。75.6%的样本接受了FGA-LAIs治疗,氟哌啶醇是最常见的处方药,其次是左氯戊醇和阿立哌唑。双相情感障碍的诊断和同时服用抗抑郁药是SGA-LAI处方的统计学显著预测因素。一些患者的特征可能会影响监狱中的处方模式。对更大样本的进一步纵向研究应该证实这些发现。
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引用次数: 0
Efficacy and safety of clozapine in treatment-resistant psychotic patients with DiGeorge syndrome (22q11.2 deletion syndrome): a case series. 氯氮平治疗DiGeorge综合征(22q11.2缺失综合征)耐药精神病患者的疗效和安全性:一系列病例。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2023-10-13 DOI: 10.1097/YIC.0000000000000513
Isabella Berardelli, Mariarosaria Cifrodelli, Carlotta Giuliani, Giulia Antonelli, Carolina Putotto, Federica Pulvirenti, Maurizio Pompili

Neuropsychiatric disorders are common manifestations in 22q11.2 deletion syndrome (22q11.2DS-DiGeorge Syndrome). Although many patients with 22q11.2DS receive antipsychotic treatment for psychotic disorders, little is known about the safety and tolerability of antipsychotics in 22q11.2DS and resistant psychosis. The aim of this case series is to describe the effectiveness as well as safety and tolerability profile coming from the real-world observation of three clinical cases affected by 22q11.2DS and treatment-resistant psychosis. We administered the following tests: the Columbia Suicide Severity Rating Scale, the Hamilton Rating Scale for Anxiety, the Positive and Negative Severity Scale, the Clinical Global Impression-Severity Scale, the Yale-Brown Obsessive-Compulsive Scale, the Beck Depression Inventory and the Beck Hopelessness Scale. All these questionnaires were administered at the first visit (T0), and then 3 (T1) 6 (T2) and 12 months after (T3). We observed a clinical improvement that remained stable at 12 months. Furthermore, in our patients, the clinical effectiveness was achieved with a very low dose of clozapine (<150 mg/day) concerning the standard dose used in idiopathic schizophrenia (>300 mg/day to 600 mg/day).

神经精神障碍是22q11.2缺失综合征(22q11.2DS-DiGeorge综合征)的常见表现。尽管许多22q11.2DS患者接受了抗精神病药物治疗,但对22q11.2DS-和耐药精神病患者的抗精神病药的安全性和耐受性知之甚少。本病例系列的目的是描述对三例受22q11.2DS和耐治性精神病影响的临床病例的真实世界观察结果的有效性、安全性和耐受性。我们进行了以下测试:哥伦比亚自杀严重程度评定量表、焦虑汉密尔顿评定量表,阳性和阴性严重程度量表、临床整体印象严重程度表、耶鲁-布朗强迫症量表、贝克抑郁量表和贝克无望量表。所有这些问卷都是在第一次访视(T0),然后在第3次(T1)、第6次(T2)和第12个月(T3)后进行的。我们观察到12个月时出现了稳定的临床改善。此外,在我们的患者中,使用非常低剂量的氯氮平(300 mg/天至600 mg/天)。
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引用次数: 0
Treatment adherence in forensic patients with schizophrenia spectrum disorders discharged on long-acting injectable antipsychotics: a comparative 3-year mirror-image study. 使用长效注射抗精神病药物出院的精神分裂症谱系障碍法医患者的治疗依从性:一项为期3年的对比镜像研究。
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2023-11-02 DOI: 10.1097/YIC.0000000000000519
Yasin Hasan Balcioglu, Sinem Ozdemir, Fatih Oncu, Ahmet Turkcan

In this retrospective 3-year mirror-image study, 81 patients with schizophrenia spectrum disorders (SSD) were categorized according to whether they were prescribed long-acting injectable antipsychotics (LAI) or not upon discharge from the inpatient forensic psychiatric unit. Antipsychotic adherence, which was staged based on the 'proportion of days covered' method, as well as other clinical outcomes was compared between pre- and post-index mirror periods. In both Oral-only (n = 46) and Oral + LAI (n = 35) groups, the number of hospitalizations, convictions and months spent in the hospital were significantly lower in the post-index period than the pre-index period. Differences in these three variables between pre- and post-index periods were NS between the two groups. A mixed effect ordinal logistic regression model with random intercept showed that the odds ratio of obtaining a higher treatment adherence score in the post-index period was more pronounced in the Oral + LAI group than in the Oral-only group, considering adherence at baseline and the length of stay during the index hospitalization as potential confounders. Discharge with LAIs in a forensic psychiatric cohort of SSD was associated with a greater mid- to long-term improvement in antipsychotic medication adherence compared to discharge with oral-only antipsychotics.

在这项为期3年的回顾性镜像研究中,81名精神分裂症谱系障碍(SSD)患者根据出院后是否服用长效注射抗精神病药物(LAI)进行了分类。根据“覆盖天数比例”方法对抗精神病依从性进行分期,并在指数镜像期前和指数镜像期后比较其他临床结果。在两个仅口头(n = 46)和Oral+LAI(n = 35)组中,住院次数、定罪次数和住院月数在指数后时期显著低于指数前时期。这三个变量在指数前后的差异在两组之间为NS。具有随机截距的混合效应有序逻辑回归模型显示,考虑到基线时的依从性和指数住院期间的住院时间是潜在的混杂因素,在指数后时期获得更高治疗依从性得分的比值比在口服+LAI组中比在仅口服组中更明显。在SSD的法医精神病学队列中,与仅口服抗精神病药物出院相比,LAI出院与抗精神病药依从性的中长期改善有关。
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引用次数: 0
Immunomodulatory options for neurodevelopmental spectrum conditions: are we there yet? 神经发育谱系疾病的免疫调节方案:我们是否已经准备就绪?
IF 2.6 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-07-01 Epub Date: 2024-01-22 DOI: 10.1097/YIC.0000000000000531
Martina Arenella

About 3-7% of the worldwide population is diagnosed with a neurodevelopmental condition, including autism and attention-deficit hyperactivity disorder. Nonetheless, the aetiology of these conditions is unclear and support options are limited or not effective for all those diagnosed. Cumulating evidence, however, supports a role of the immune system in neurodevelopment, and immune dysregulations have been implicated in neurodevelopmental atypicalities. This knowledge offers tremendous opportunities, especially the possibility to adopt immunomodulatory compounds, which are already available and safe to use, for the management of neurodevelopmental difficulties. This perspective discusses the potential of immune-based interventions in neurodevelopmental care. Here, the application of existing immunomodulatory compounds to symptom management is justified by findings of immune dysregulations across neurodevelopmental conditions and preliminary, encouraging immune-based clinical trials. Still, key considerations are presented, specifically the necessity of immune biomarkers to ensure the right support option for the right (subgroup of) individuals within the neurodevelopmental spectrum.

全世界约有 3%-7% 的人被诊断患有神经发育疾病,包括自闭症和注意力缺陷多动障碍。然而,这些疾病的病因尚不清楚,对所有确诊患者的支持方案也很有限,甚至无效。然而,不断积累的证据表明,免疫系统在神经发育过程中扮演着重要角色,免疫失调与神经发育异常有关。这方面的知识提供了巨大的机遇,尤其是采用免疫调节化合物治疗神经发育障碍的可能性。本视角讨论了基于免疫的干预措施在神经发育护理中的潜力。在这里,现有免疫调节化合物在症状治疗中的应用是合理的,因为在神经发育疾病中发现了免疫失调现象,而且基于免疫的临床试验也取得了初步的、令人鼓舞的成果。此外,还提出了一些关键的考虑因素,特别是免疫生物标志物的必要性,以确保为神经发育谱系中正确的(亚群)个体提供正确的支持方案。
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引用次数: 0
Validation of the Spanish version of the multifaceted empathy test: comparison between cannabis use effects and controls in social cognition. 西班牙文版多方面移情测试的验证:使用大麻影响与社会认知对照组的比较。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-06-28 DOI: 10.1097/YIC.0000000000000544
Alberto Sainz-Cort, Marta Martín-Islas, Daniel Jimenez-Garrido, Miriam López-Navarro, Genís Oña, Elena Muñoz-Marron, Luis Heredia, Mercè Gil-Pérez, Margarita Torrente, Paloma Vicens, José Carlos Bouso

Objective: While social cognition is shown to be impaired in several mental disorders, the effects of cannabis on social cognition are still not clear. Past studies have used the multifaceted empathy test (MET) to study social cognition. This study aims to test the validity of the MET Spanish version and to evaluate the effects of cannabis use on social cognition.

Methods: In total 116 participants from a Cannabis Social Club (CSC) completed the MET and the reading the mind in the eyes test (RMET) under the effects of cannabis and were compared to 86 university students (control group). Internal consistency and convergent validity were assessed. Cognitive empathy (CE) and emotional empathy (EE) were tested in both groups.

Results: The MET CE scale shows low internal consistency, while the EE scale shows high internal consistency. Items showed similar difficulty for both groups. Cannabis users showed deficient overall emotional recognition, with reduced scores associated with positive stimuli. Overall scores for EE were similar for both groups, but the experimental group scored lower with negative stimuli when compared to controls.

Conclusion: This study validates the MET Spanish version for its use in future studies. Results confirmed deficient emotional recognition in cannabis users and a dampened reaction to negative stimuli for the first time.

目的:虽然多种精神疾病都显示社交认知能力受损,但大麻对社交认知能力的影响仍不明确。以往的研究使用多方面移情测试(MET)来研究社会认知。本研究旨在测试 MET 西班牙语版本的有效性,并评估吸食大麻对社会认知的影响:共有 116 名来自大麻社交俱乐部(CSC)的参与者在大麻作用下完成了 MET 和读心术测试(RMET),并与 86 名大学生(对照组)进行了比较。对内部一致性和收敛有效性进行了评估。对两组学生的认知移情(CE)和情感移情(EE)进行了测试:结果:MET CE 量表的内部一致性较低,而 EE 量表的内部一致性较高。两组的项目难度相似。大麻使用者的总体情绪识别能力不足,与积极刺激相关的得分降低。两组的 EE 总分相似,但与对照组相比,实验组对负面刺激的得分较低:本研究验证了 MET 西班牙语版本在未来研究中的应用。研究结果首次证实了大麻使用者的情绪识别能力不足以及对负面刺激的反应减弱。
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引用次数: 0
Understanding and treating postpartum depression: a narrative review. 了解和治疗产后抑郁症:叙述性综述。
IF 2.1 3区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-06-17 DOI: 10.1097/YIC.0000000000000560
Vincenzo Cardaci, Matteo Carminati, Mattia Tondello, Basilio Pecorino, Alessandro Serretti, Raffaella Zanardi

Postpartum depression (PPD) is an increasingly prevalent but still poorly characterized disorder. Causal and modulating factors include hormones fluctuations, such as estrogen, progesterone, and allopregnolone, pathways imbalances, such as oxytocin and kynurenine, chronobiological factors, and brain imaging alterations. Treatment may differ from the traditional major depression management, while selective serotonin reuptake inhibitors such as sertraline are commonly used and suggested by guidelines, neurosteroids such as brexanolone and the more convenient zuranolone have been recently approved. Newer neurosteroids such as ganaxolone, valaxanolone, and lysaxanolone are currently under development, but also esketamine and psychedelics are promising potential treatments. Other somatic treatments including brain stimulation techniques and light therapy also showed benefit. PPD is therefore increasingly understood as, at least partially, independent from major depressive disorder. Specific and individualized treatments including pharmacological and non-pharmacological therapies are progressively being introduced in the routine clinical practice.

产后抑郁症(PPD)是一种发病率越来越高但特征仍然不明显的疾病。致病和调节因素包括激素波动(如雌激素、孕酮和异孕酮)、途径失衡(如催产素和犬尿氨酸)、时间生物学因素和脑成像改变。虽然选择性血清素再摄取抑制剂(如舍曲林)是常用药物,也是指南推荐的药物,但神经类固醇(如布来昔诺龙)和更方便的唑来诺龙最近已获得批准。较新的神经类固醇药物,如甘舒龙、缬舒龙和来舒龙目前正在研发中,而开塞露和迷幻药也是很有前景的潜在治疗方法。包括脑刺激技术和光疗在内的其他体外疗法也显示出了疗效。因此,人们越来越认识到,PPD 至少部分独立于重度抑郁症。包括药物和非药物疗法在内的具体和个性化治疗方法正逐步被引入常规临床实践中。
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引用次数: 0
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International Clinical Psychopharmacology
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