台灣精神分裂症藥物治療：文獻整理

Pharmacological Studies on Patients with Schizophrenia in Taiwan: A Compilation of Literature

背景：台灣精神醫學界對精神分裂症之藥物學研究成果非常豐富，擬為近年來發表於 國際期刊論文作分類摘要整理。方法：以「抗精神病藥物」、「精神分裂症」及「台灣」 為關鍵字，於醫學期刊文獻資料庫(PubMed) 搜尋台灣精神醫學界發表於國際期刊之論文。 結果：研究論文依主題整理分為十類，包括療效研究、劑量調整、合併療法、藥物動力學、 認知功能、治療預後、藥物副作用、藥物流行病學、藥物經濟學及藥物基因等類別。整體 而言，除clozapine 顯示有較佳療效外，其他抗精神病藥物療效相當，但副作用則有顯著差 異。本土研究於藥物副作用之監測及處理、劑量調整、合併療法、藥物動力學等研究已有重 要成果，可為臨床處理重要參考資料。療效及副作用的藥物基因學研究也相當豐富，為未來 個人化治療提供重要資料，但仍需更多研究來驗證結果。相對而言在藥物認知功能、臨床預 後及藥物經濟學的研究則較少。結論：台灣精神醫學界於精神分裂症之藥物學研究已有豐富 研究成果，將可作為台灣精神分裂症藥物治療共識之基礎

Our Taiwan psychiatrists have actively studied pharmacotherapy in patients with schizophrenia. A compilation of lileration on this topic to gain an overview of pharmacological studies of schizophrenia in Taiwan is useful for psychiatrists in Taiwan to get quick and handy references. I identifi ed Science Citation Index (SCI)-papers with the electronic search on the key words “antipsychotic,” “schizophrenia,” and “Taiwan” in PubMed (www.ncbi.nlm.nih.gov/pubmed). These articles were identifi ed and annotated into 10 categories: (A) effi cacy studies, including randomized double blind comparative studies, randomized single blind comparative studies, and open trials; (B) dose tuning; (C) augmentation therapy; (D) pharamcokinetic studies; (E) cognitive function; (F) prognosis; (G) side effects; (H) pharmaco-epidemiology; (I) pharmaco-economics; (J) pharmaco-genetics. Many Taiwan studies have offered empirical results of pharmacotherapy for schizophrenia in Taiwan. Besides clozapine, which is superior in effi cacy, most studies showed comparable effi cacy in treating schizophrenia among the different antipsychotic drugs, but with different side effect profi les. Many studies on monitoring and managing the side effects offered important references. The reports on dose tuning, augmentation with pharmacokinetic interaction, combination therapy or NMDA augmentation offered empirical evidence for clinical applications. The pharmaco-genetic studies showed evidence of genetic markers to predict effi cacy and side effects in our Taiwan patients, trying to achieve the goal of individualized pharmacotherapy. But more studies are required to validate the results. The studies on cognition, clinical outcomes, pharmaco-economics are still limited in number. These studies have offered empirical results of pharmacotherapy for schizophrenia in Taiwan, and will be the basis for the development of the Taiwan consensus of pharmacological treatment for schizophrenia.