BACKGROUND & AIMS: We report the response to risperidone in seven hospitalized, adult patients who presented psychotic symptoms etiologically related to a general medical condition. The conditions included brain surgery in two, and anticardiolipin syndrome, renal failure, epilepsy, lupus, and metastatic carcinoma in one each. Four patients had failed previous treatment with at least one typical antipsychotic agent. Response to risperidone was assessed by the Brief Psychiatric Rating Scale (BPRS). Serum was collected for measurement of steady-state trough risperidone and 9-hydroxyrisperidone concentrations at effective doses in three patients. Amelioration of psychotic symptoms was noted in all seven patients. Mean (+/- SD) BPRS scores were reduced significantly from baseline (63.0 +/- 15.1) to endpoint (27.0 +/- 3.5; p < 0.01). The mean effective daily dose of risperidone was 3.1 +/- .7 mg and time to response was 4.7 +/- 2.4 days. Risperidone was not present at detectable concentrations in the three patients studied. The mean steady-state trough serum concentration of 9-hydroxyrisperidone in the three patients assessed was 20.3 +/- 9.8 ng/ml. These preliminary findings, which suggest that risperidone is a safe and effective agent in patients with psychotic symptoms due to various medical conditions, need to be confirmed by randomized, antipsychotic comparison trials involving a larger number of patients.

背景与目标： 我们报告了七名住院的成年患者对利培酮的反应，这些患者在病因学上呈现出与一般医疗状况相关的精神病症状。这些疾病包括脑外科手术两次，抗心磷脂综合症，肾衰竭，癫痫，狼疮和转移性癌各一次。四名患者先前接受了至少一种典型的抗精神病药治疗失败。通过简要精神病评定量表（BPRS）评估对利培酮的反应。收集血清以测量三位患者在有效剂量下的稳态谷型利培酮和9-羟基利培酮浓度。在所有七名患者中均发现精神病症状得到改善。从基线（63.0 /-15.1）到终点（27.0 /-3.5； p <0.01），平均（±SD）BPRS得分显着降低。利培酮的平均有效日剂量为3.1 /-.7 mg，响应时间为4.7 /-2.4天。在研究的三位患者中，未检测到利培酮的存在。在所评估的三名患者中，9-羟基利培酮的平均稳态谷浓度为20.3 /-9.8 ng / ml。这些初步发现表明，利培酮是治疗各种疾病引起的精神病症状患者的一种安全有效的药物，需要通过涉及更多患者的随机抗精神病药物比较试验来证实。

BACKGROUND & AIMS: :The extended amygdala has been proposed to play an essential role in cognitive and affective processes and in neuropsychiatric disorders. In the present study, we examined the induction of Fos-like nuclei in the central amygdaloid nucleus (CeA), sublenticular extended amygdala (SLEA), interstitial nucleus of the posterior limb of the anterior commissure (IPAC), and bed nucleus of the stria terminalis (BSTL) of rodents to improve the knowledge regarding the pharmacological profile, therapeutic efficacy, and side-effects of olanzapine, an atypical antipsychotic drug and risperidone, a mixed atypical/typical antipsychotic drug in the rat brain. In addition, we evaluated the induction of Fos-like-nuclei in areas connected with these structures such as prefrontal cortex (PFCx), and nucleus accumbens shell, and in other important areas including the lateral septum and caudate-putamen that are involved in the therapeutic efficacy or side-effects of antipsychotic drugs. Fos-like-immunoreactivity induced by olanzapine and risperidone was compared with that by the atypical antipsychotic clozapine and typical antipsychotic haloperidol. Regarding the extended amygdala, and similarly to clozapine, olanzapine (5-10 mg/kg) and, with a lower efficacy, risperidone (1-3 mg/kg), induced Fos-like-nuclei in CeA, IPAC, SLEA, and BSTL. Both these drugs increased the induction of Fos-like-nuclei in PFCx, nucleus accumbens shell, lateral septum, and caudate-putamen. On the contrary, the increase of Fos-like-nuclei in the extended amygdala by haloperidol was restricted to IPAC only. These findings, consistent with the important role of extended amygdala in neuropsychiatric disorders characterized by affective disturbances, showed that olanzapine and risperidone, contrary to haloperidol, preferentially activated Fos-expression in these brain areas.

背景与目标： ：已提出扩大杏仁核在认知和情感过程以及神经精神疾病中起重要作用。在本研究中，我们研究了中央杏仁核（CeA），扁桃体下杏仁核（SLEA），前连合后肢的间质核（IPAC）和纹状体床核的Fos样核的诱导啮齿类动物终末期（BSTL），以提高有关奥氮平（一种非典型的抗精神病药物）和利培酮（一种混合的非典型/典型的抗精神病药物）在大鼠脑中的药理作用，治疗功效和副作用的知识。此外，我们评估了与这些结构相关的区域（如前额叶皮层（PFCx）和伏隔核壳）以及其他重要区域（包括外侧中隔和尾状丘脑）的Fos样核的诱导。抗精神病药的治疗功效或副作用。将奥氮平和利培酮诱导的Fos样免疫反应性与非典型抗精神病药物氯氮平和典型的抗精神病药物氟哌啶醇进行比较。关于扩大的杏仁核，与氯氮平相似，奥氮平（5-10mg / kg）和利培酮（1-3mg / kg）疗效较差，在CeA，IPAC，SLEA和BSTL。这两种药物都增加了PFCx，伏隔核壳，外侧中隔和尾状豆核中Fos样核的诱导。相反，氟哌啶醇增加杏仁核中Fos样核的数量仅限于IPAC。这些发现与杏仁核延长在以情感障碍为特征的神经精神疾病中的重要作用一致，表明奥氮平和利培酮与氟哌啶醇相反，优先激活了这些大脑区域的Fos表达。

BACKGROUND & AIMS: BACKGROUND:Acute eosinophilic pneumonia (AEP) is a severe syndrome which can be induced for many reasons, including drugs. AEP has rarely been associated with first-generation antipsychotics and never been reported after use of second-generation antipsychotics, such as risperidone. CASE REPORT:We report a case of a 64-year-old man with a medical history of alchoholism and paranoid symptoms, treated with risperidone at low doses. Following risperidone medication, he presented with respiratory distress. Bronchoalveolar lavage (BAL) specimen was indicated of AEP. All evidence indicated risperidone as the most probable causal factor. The syndrome rapidly resolved after discontinuation of the drug. DISCUSSION:Pathophysiological mechanisms implicated in the development of AEP in our patient seem to be associated with eotaxin and serotonin eosinophilic-specific chemoattracting action, through the serotoninergic action of risperidone. CONCLUSION:To our knowledge, this is the first case report of a clinical adverse reaction of AEP from an atypical antipsychotic agent (risperidone).

背景与目标： 背景：急性嗜酸性粒细胞性肺炎（AEP）是一种严重的综合症，可由于多种原因引起，包括药物。 AEP很少与第一代抗精神病药有关，并且在使用第二代抗精神病药（如利培酮）后从未见过报道。
病例报告：我们报告了一例64岁的男性，患有酒精中毒和偏执症状，曾接受低剂量利培酮治疗。服用利培酮治疗后，他出现呼吸窘迫。支气管肺泡灌洗（BAL）标本显示为AEP。所有证据均表明利培酮是最可能的原因。停药后该综合征迅速消退。
讨论：我们患者中与AEP发生有关的病理生理机制似乎与利培酮的5-羟色胺能与嗜酸性粒细胞嗜酸性粒细胞趋化作用有关。
结论：据我们所知，这是第一例非典型抗精神病药（利培酮）引起的AEP临床不良反应的病例报告。

BACKGROUND & AIMS: :When an antipsychotic drug is given repeatedly and intermittently, there is often a long-term increase in its behavioral efficacy, termed antipsychotic sensitization. With the passage of time, the magnitude of antipsychotic sensitization may increase or decrease based on the principle of time-dependent sensitization (TDS) or memory decay, respectively. In the present study, we examined the time-dependent feature and possible dopamine D2 receptor mechanism of sensitization induced by risperidone and asenapine in the conditioned avoidance response test. Well-trained male adult Sprague-Dawley rats were first repeatedly treated with risperidone (1.0mg/kg) or asenapine (0.2mg/kg) and tested for avoidance response daily for 5 consecutive days. Eight, 18 or 38 days after the 5th drug treatment, all rats were retested drug-free to assess the long-term impact of prior risperidone or asenapine treatment. Drug-pretreated rats had significantly lower avoidance than vehicle-pretreated ones on this test, and the group differences increased with the passage of time. In the subsequent drug challenge test at 10, 20 or 40 days after the 5th drug treatment, all rats were injected with a low dose of risperidone (0.3mg/kg) or asenapine (0.1mg/kg). Drug-pretreated rats again made significantly fewer avoidances than controls, confirming the antipsychotic sensitization effect. Finally, in the quinpirole (a D2/3 receptor agonist, 1.0mg/kg, sc)-induced hyperlocomotion test, risperidone-pretreated rats exhibited a significantly higher level of motor activity than the vehicle-pretreated ones. These findings suggest that risperidone and asenapine sensitization is long-lasting, follows the TDS principle, and is likely mediated by D2 receptor supersensitivity.

背景与目标： ：反复或间断使用抗精神病药时，其行为功效通常会长期增加，这被称为抗精神病药致敏作用。随着时间的流逝，基于时间依赖性敏化（TDS）或记忆衰退的原理，抗精神病药敏化的幅度可能会增加或降低。在本研究中，我们在条件回避反应测试中检查了利培酮和阿塞那平致敏的时间依赖性特征和可能的多巴胺D2受体致敏机制。训练有素的雄性成年Sprague-Dawley大鼠首先反复使用利培酮（1.0mg / kg）或阿塞那平（0.2mg / kg）进行治疗，并连续5天每天进行回避反应测试。第5次药物治疗后第8、18或38天，所有大鼠均重新进行了无药物测试，以评估先前使用利培酮或阿塞那平治疗的长期影响。在该试验中，药物预处理的大鼠回避率明显低于媒介物预处理的大鼠，且随着时间的流逝，组间差异有所增加。在第5次药物治疗后第10、20或40天进行的后续药物激发试验中，所有大鼠均被注射低剂量的利培酮（0.3mg / kg）或阿塞那平（0.1mg / kg）。药物预处理的大鼠回避率也大大低于对照组，证实了抗精神病药的致敏作用。最后，在喹吡罗（D2 / 3受体激动剂，1.0mg / kg，皮下注射）诱导的运动过度试验中，利培酮预处理的大鼠表现出比运载体预处理的大鼠明显更高的运动活动水平。这些发现表明，利培酮和阿塞那平的致敏作用是持久的，遵循TDS原理，并且可能由D2受体超敏作用介导。

BACKGROUND & AIMS: :Mixed states are common and severe manifestations of bipolar disorder, with limited data on the differential efficacy of treatments on depressive and manic symptoms. This study assessed the effectiveness of open-label adjunctive risperidone in achieving sustained effectiveness in patients with mixed mania, with a specific focus on the differential benefits on manic and depressive symptomatology. Forty patients with bipolar disorder I, currently in a mixed manic episode, were treated with adjunctive risperidone. Behavioral measures at baseline and weeks 1, 2, 4, 8, 12, 16, and 20 were assessed using the following scales: the Young Mania Rating Scale, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment Scale. The primary outcome measure was the proportion of patients who attained a sustained response on either depressive or manic symptomatology, defined as at least 50% reduction from the baseline on the Montgomery Asberg Depression Rating Scale or the Young Mania Rating Scale, maintained over at least 8 weeks without subsequent relapse during the 20-week trial. A significantly higher proportion of patients achieved a sustained response for mania than depression, 16/40 versus 6/40, respectively (McNemar's χ² 8.33, P=0.004). Higher elevated mood at baseline and lower apparent sadness (P<0.016) each predicted a sustained response for mania (P<0.0001). Mixed manic patients who were treated with risperidone adjunctive to mood stabilizer/s for 20 weeks were significantly more likely to achieve a sustained response for manic than for depressive symptomatology.

背景与目标： ：混合状态是双相情感障碍的常见和严重表现，有关抑郁症和躁狂症状的不同治疗效果的数据有限。这项研究评估了开放标签的辅助利培酮在混合躁狂症患者中获得持续疗效的有效性，特别侧重于躁狂和抑郁症状的不同获益。目前正在混合躁狂发作的40例I型双相情感障碍患者接受了辅助性利培酮治疗。使用以下量表评估基线和第1、2、4、8、12、16和20周的行为测量：年轻躁狂症评定量表，蒙哥马利·阿斯伯格抑郁评定量表（MADRS）和全球评估量表。主要结局指标是对抑郁或躁狂症状持续缓解的患者比例，定义为蒙哥马利·阿斯伯格抑郁量表或年轻躁狂症量表与基线相比降低至少50％，并保持至少8连续20周的试验期间没有复发。持续的躁狂反应比抑郁症要高得多，分别为16/40和6/40（McNemar'sχ28.33，P = 0.004）。基线时较高的情绪升高和较低的表观悲伤度（P <0.016）均预示了躁狂的持续反应（P <0.0001）。混合使用躁狂稳定剂利培酮治疗20周的躁狂患者，与抑郁症状相比，躁狂持续缓解的可能性显着更高。

BACKGROUND & AIMS: Risperidone is an antipsychotic drug with high affinity at dopamine D2 and serotonin 5-HT2 receptors. Previous clinical studies have proposed that risperidone's pharmacologic profile may produce improved efficacy for negative psychotic symptoms and decreased propensity for extrapyramidal side effects; features shared by so-called 'atypical' neuroleptics. To determine if routine risperidone treatment is associated with a unique degree of D2 receptor occupancy and pattern of clinical effects, we used [123I]IBZM SPECT to determine D2 occupancy in subjects treated with routine clinical doses of risperidone (n = 12) or haloperidol (n = 7). Both risperidone and haloperidol produced D2 occupancy levels between approximately 60 and 90% at standard clinical doses. There was no significant difference between occupancy levels obtained with haloperidol or risperidone. Drug-induced parkinsonism was observed in subjects treated with risperidone (42%) and haloperidol (29%) and was observed at occupancy levels above 60%. Based on these observations, it is concluded that 5-HT2 blockade obtained with risperidone at D2 occupancy rates of 60% and above does not appear to protect against the risk for extrapyramidal side effects.

背景与目标： 利培酮是一种对多巴胺D2和5-羟色胺5-HT2受体具有高亲和力的抗精神病药。先前的临床研究表明，利培酮的药理作用可能会改善精神病阴性症状的疗效，并降低锥体束外副作用的发生率。所谓的“非典型”抗精神病药共有的功能。为了确定常规的利培酮治疗是否与D2受体的独特程度和临床疗效模式相关，我们使用[123I] IBZM SPECT来确定接受常规临床剂量的利培酮（n = 12）或氟哌啶醇（ n = 7）。在标准临床剂量下，利培酮和氟哌啶醇均可产生约60％至90％的D2占用水平。氟哌啶醇或利培酮的使用率之间无显着差异。在使用利培酮（42％）和氟哌啶醇（29％）治疗的受试者中观察到药物诱发的帕金森综合症，并且在超过60％的占用水平下观察到。基于这些观察结果，可以得出结论，使用利培酮在D2占有率为60％或更高的情况下获得的5-HT2阻滞作用似乎并不能防止发生锥体束外副作用的风险。

BACKGROUND & AIMS: BACKGROUND:A significant number of women of childbearing age have schizophrenia or other psychoses. This means that there is a considerable risk of in utero exposure to risperidone due to maternal use. OBJECTIVE:To determine whether in utero exposure to the atypical antipsychotic risperidone is associated with poor pregnancy and fetal/neonatal outcomes. METHODS:A search of the Benefit Risk Management Worldwide Safety database, using a selection of preferred terms from the Medical Dictionary of Regulatory Activities, was performed to identify all cases of pregnancy or fetal/neonatal outcomes reported in association with risperidone treatment from its first market launch (international birth date, 1 June 1993) to 31 December 2004. The main measures were the patterns and reporting rates of pregnancy (stillbirth and spontaneous and induced abortion) and fetal/neonatal outcomes (congenital abnormalities, perinatal syndromes and withdrawal symptoms) for women administered risperidone during pregnancy. RESULTS:Overall, 713 pregnancies were identified in women who were receiving risperidone. Data were considered prospective in 516 of these, and retrospective in the remaining 197 cases. The majority of the known adverse pregnancy and fetal/neonatal outcomes were retrospectively reported. Of the 68 prospectively reported pregnancies with a known outcome, organ malformations and spontaneous abortions occurred 3.8% and 16.9% (when the 15 induced abortions were excluded from the denominator, as they were predominantly undertaken for nonmedical reasons), respectively, a finding consistent with background rates of the general population. There were 12 retrospectively reported pregnancies involving major organ malformations, the most frequently reported of which affected the heart, brain, lip and/or palate. There were 37 retrospectively reported pregnancies involving perinatal syndromes, of which 21 cases involved behavioural or motor disorders. In particular, there was a cluster of cases reporting tremor, jitteriness, irritability, feeding problems and somnolence, which may represent a withdrawal-emergent syndrome. CONCLUSION:This comprehensive review of the Benefit Risk Management Worldwide Safety database for case reports of risperidone exposure during pregnancy represents the largest ever published dataset documenting pregnancy outcomes for women taking the atypical antipsychotic risperidone. It indicates that in utero exposure to risperidone does not appear to increase the risk of spontaneous abortions, structural malformations and fetal teratogenic risk above that of the general population. Self-limited extrapyramidal effects in neonates were observed after maternal exposure to risperidone during the third trimester of pregnancy. Risperidone should only be used during pregnancy if the benefits outweigh the potential risks.

背景与目标： 背景：许多育龄妇女患有精神分裂症或其他精神病。这意味着由于母体使用，子宫内存在利培酮的相当大的风险。
目的：确定宫内暴露于非典型抗精神病药物利培酮是否与不良妊娠和胎儿/新生儿结局有关。
方法：使用“监管活动医学词典”中的一些首选术语，对“全球利益风险管理全球安全性”数据库进行搜索，以识别首次上市时与利培酮治疗相关的所有妊娠或胎儿/新生儿结局病例发射（国际出生日期，1993年6月1日）至2004年12月31日。主要测量指标为：妇女在怀孕期间服用利培酮。
结果：总体上，接受利培酮治疗的女性中有713例怀孕。其中516例被认为是前瞻性数据，其余197例被视为回顾性数据。回顾性报告了大多数已知的不良妊娠和胎儿/新生儿结局。在68例结果已知的妊娠报告中，器官畸形和自然流产发生率分别为3.8％和16.9％（当15例人工流产因非医学原因而被排除在分母时），这一发现与普通人群的本底率。回顾性报告了12例妊娠，涉及主要器官畸形，其中最常报告的妊娠累及心脏，大脑，嘴唇和/或上颚。回顾性报告了37例涉及围产期综合征的妊娠，其中21例涉及行为或运动障碍。特别是，有一系列报告震颤，发抖，易怒，进食问题和嗜睡的病例，这可能代表戒断综合征。
结论：这份对全球利益风险管理全球安全性数据库的全面审查，包括妊娠期间服用利培酮的病例报告，是有史以来出版量最大的数据集，记录了服用非典型抗精神病药利培酮的妇女的妊娠结局。这表明子宫内暴露于利培酮的行为似乎并未增加自发流产，结构畸形和胎儿致畸风险的风险，超过了一般人群。孕妇在孕晚期暴露于利培酮后，在新生儿中出现了自我限制的锥体外系作用。如果利培酮的益处大于潜在的风险，则应仅在妊娠期间使用利培酮。

BACKGROUND & AIMS: OBJECTIVE:To evaluate outcomes of clinical use of risperidone long-acting injection (RLAI) and determine factors predicting continuation with treatment. METHOD:This prospective, 3-year follow-up of consecutive patients started on treatment with RLAI in normal clinical practice between August 2002 and September 2003 obtained demographic and clinical data from case notes, prescription charts, and hospital computer records. To determine predictors of continuation, a proportional hazards regression (Cox) model was constructed. RESULTS:The study included 211 evaluable patients. Over 3 years, 84% of subjects discontinued RLAI; 27.7% of these switched to oral risperidone. The Cox model showed that younger age (p = .001), longer duration of illness (p = .001), inpatient status at initiation (p = .002), and an RLAI dose of 25 mg/2 weeks (p < .001) predicted greater probability of discontinuation. CONCLUSION:A small proportion of patients initiated on treatment with RLAI continued for 3 years. Outcome is likely to be improved by targeting RLAI treatment at specific patient groups and by using a dose of more than 25 mg/2 weeks.

背景与目标： 目的：评估利培酮长效注射剂（RLAI）的临床使用结果，并确定预测继续治疗的因素。
方法：这项对连续患者进行的为期3年的前瞻性随访，从2002年8月至2003年9月在正常临床实践中开始接受RLAI治疗，从病例记录，处方表和医院计算机记录中获得了人口统计学和临床​​数据。为了确定持续性的预测因素，构建了比例风险回归（Cox）模型。
结果：该研究包括211名可评估的患者。在3年中，有84％的受试者终止了RLAI；其中27.7％改用口服利培酮。 Cox模型显示年龄更小（p = .001），病程更长（p = .001），开始时的住院状态（p = .002）和RLAI剂量为25 mg / 2周（p <。 001）预测停产的可能性更大。
结论：一小部分开始接受RLAI治疗的患者持续3年。通过针对特定患者组进行RLAI治疗并使用超过25 mg / 2周的剂量，可能会改善结果。

BACKGROUND & AIMS: OBJECTIVES:To evaluate the effectiveness and safety of risperidone in children and adolescents with bipolar disorder characterized by aggression and mania, despite treatment with mood stabilizers. METHODS:A retrospective chart review of patients seen in an outpatient pediatric mood disorders clinic over an 18-month period was performed. Data were extracted from charts of patients who had a diagnosis of bipolar disorder with aggression that was uncontrolled on a mood stabilizer; as a result, these patients had risperidone added to their regimen. RESULTS:Four boys (aged 7-15 years) and two girls (aged 8 and 14 years) were treated with risperidone (mean dosage, 0.85 mg/day) for 3-16 months. Aggressive behavior improved in all patients after risperidone was started and remained improved for the duration of follow-up. Other symptoms of mania also improved. Risperidone was generally well tolerated. Sedation and akathisia were reported in one patient. CONCLUSIONS:The addition of risperidone to a mood stabilizer may improve aggression and other symptoms of mania in pediatric patients with bipolar disorder who do not respond adequately to a mood stabilizer alone. The long-term efficacy and safety of this regimen should be evaluated in a controlled clinical trial.

背景与目标： 目的：评估利培酮在以情绪低落为特征的双相情感障碍儿童和青少年中的有效性和安全性，尽管使用了情绪稳定剂进行了治疗。
方法：对在门诊儿科情绪障碍诊所接受治疗的18个月内的患者进行回顾性图表审查。数据是从诊断为躁郁症的躁郁症患者的图表中提取的，这些患者的情绪稳定剂无法控制；结果，这些患者的方案中增加了利培酮。
结果：四个男孩（7-15岁）和两个女孩（8和14岁）接受利培酮（平均剂量0.85 mg /天）治疗3-16个月。开始使用利培酮后所有患者的攻击行为均得到改善，并在随访期间保持改善。躁狂症的其他症状也有所改善。利培酮通常耐受良好。据报道一名患者出现镇静和静坐不全。
结论：在情绪稳定剂中加入利培酮可能会改善躁郁症儿科患者的攻击性和躁狂症的其他症状，这些患者不能单独对情绪稳定剂产生足够的反应。该方案的长期疗效和安全性应在对照临床试验中进行评估。

BACKGROUND & AIMS: :Data from the EMBLEM Study, a 2-year, prospective, observational study of health outcomes associated with acute treatment of patients experiencing a manic/mixed episode of bipolar disorder, was used to compare the effectiveness of olanzapine monotherapy versus risperidone monotherapy, and to investigate whether the treatment effects were similar to those reported in a 3-week, randomized controlled trial assessing the same treatments. Symptom severity measures included the Young Mania Rating Scale (YMRS), the 5-item Hamilton Depression Rating Scale, and the Clinical Global Impression-Bipolar Disorder Scale. A total of 245 EMBLEM inpatients were analyzed with YMRS >or=20: olanzapine (n=209), risperidone (n=36). Both the treatment groups had similar improvements in YMRS from baseline to 6 weeks, but there was a significantly greater improvement in 5-item Hamilton Depression Rating Scale in the olanzapine group. There was a similar improvement in Clinical Global Impression-Bipolar Disorder Scale in both the groups and the occurrence of treatment-emergent adverse events and weight gain did not differ between the treatment groups. The EMBLEM results partly support those of the randomized controlled trial, which suggests olanzapine and risperidone have similar improvements in mania but that olanzapine monotherapy may be more effective than risperidone monotherapy in the treatment of depressive symptoms associated with mania. Limitations include differences in study design, patient population, and length of follow-up.

背景与目标： ：来自EMBLEM研究的数据是一项为期2年的前瞻性，观察性研究，涉及与躁狂/躁狂混合发作的躁郁症患者急性治疗相关的健康结局，用于比较奥氮平单药治疗与利培酮单药治疗的有效性，并且调查治疗效果是否与评估相同治疗的3周随机对照试验中报道的效果相似。症状严重程度包括年轻躁狂量表（YMRS），5项汉密尔顿抑郁量表和临床总体印象-双相情感障碍量表。共有245名EMBLEM住院患者接受YMRS≥20的分析：奥氮平（n = 209），利培酮（n = 36）。从基线到第6周，两个治疗组的YMRS均有相似的改善，但奥氮平组的5项汉密尔顿抑郁量表的改善显着更大。两组的临床总体印象-双相情感障碍量表都有相似的改善，并且在治疗组之间出现治疗紧急不良事件和体重增加的情况没有差异。 EMBLEM结果部分支持随机对照试验的结果，该结果表明奥氮平和利培酮在躁狂症方面有相似的改善，但奥氮平单一疗法在治疗与躁郁症相关的抑郁症状方面可能比利培酮单一疗法更有效。局限性包括研究设计，患者人群和随访时间的差异。

BACKGROUND & AIMS: PURPOSE:Intraoperative floppy iris syndrome (IFIS) has been strongly associated with intake of selective a1 adrenergic blockers, particularly tamsulosin. Intraoperative floppy iris syndrome has also been linked to the use of other drugs with some a antagonist activity. METHODS:We identified patients on long-term treatment with the antipsychotic agent risperidone who showed typical features of IFIS during cataract surgery. RESULTS:We report 3 eyes in 2 patients taking risperidone in which typical features of IFIS were noted during cataract surgery. CONCLUSIONS:Risperidone is a widely prescribed drug in psychiatric practice and has a-blocking actions as well as strong affinity for serotonin 2A receptors. Ophthalmologists should be aware of the possible association with IFIS when performing cataract surgery on patients taking risperidone.

背景与目标： 目的：术中软性虹膜综合症（IFIS）与选择性a1肾上腺素能阻滞剂（尤其是坦索罗辛）的摄入密切相关。术中软性虹膜综合症也与使用其他具有拮抗作用的药物有关。
方法：我们确定长期接受抗精神病药利培酮治疗的患者在白内障手术期间表现出IFIS的典型特征。
结果：我们报告了2名服用利培酮的患者中有3只眼，其中白内障手术期间注意到IFIS的典型特征。
结论：利培酮是在精神病学实践中被广泛处方的药物，具有阻断作用以及对5-羟色胺2A受体的强亲和力。眼科医师应在接受利培酮治疗的患者进行白内障手术时意识到与IFIS的可能联系。

BACKGROUND & AIMS: OBJECTIVES:Second-generation antipsychotics (SGAs) increase appetite and weight, leading toward a metabolic syndrome. Risperidone and aripiprazole, the most widely used pediatric SGAs, have been studied predominantly in short-term clinical trials, where risperidone leads to a rapid weight increase and aripiprazole to a slower one, while long-term effects are not yet elucidated. Factors that may influence weight gain are likewise not clarified, although baseline weight, previous SGA exposure, pubertal status, and type of SGA have been suggested as moderators. We analyzed weight gain induced by risperidone and aripiprazole in a sample of pediatric outpatients enrolled into a 2-year observational study. METHODS:We assessed at several time points their body mass index (BMI)-Z scores (age and sex-corrected and referred to national norms). We used hierarchical mixed-effects modeling to design BMI-Z trajectories and observed the effects of several variables on determining them. RESULTS:The study group comprised of 127 patients, predominantly males (79%), of 12.6 years on average, treated with risperidone (81%) and aripiprazole (19%) for disruptive behavioral symptoms in patients with and without neurodevelopmental disorders. Overall, BMI-Z was 1.2 at first and 1.4 at last visit (no significant change). We could design four weight-change trajectories, determined by the factors: drug (risperidone/aripiprazole) and age status (children/adolescent). Additional factors not retained in the model but possibly explanatory include the previous duration of SGA treatment and a progressive patient-selection effect due to dropouts in this observational study. Risperidone treatment was associated with trends of BMI-Z increase in children and decrease in adolescents. Aripiprazole treatment was associated with significant BMI-Z increase, higher in children than in adolescents. Results are probably due to longer previous drug exposure in adolescents. CONCLUSIONS:Children were at risk of weight gain more than adolescents, for both risperidone and, of note, aripiprazole. Adolescents and patients with long previous drug exposure tend to reach stable BMI-Z, although in the range between excessive weight and obesity.

背景与目标： 目的：第二代抗精神病药（SGA）会增加食欲和体重，从而导致新陈代谢综合症。利培酮和阿立哌唑是最广泛使用的儿科SGA，主要是在短期临床试验中进行研究，其中利培酮导致体重迅速增加，阿立哌唑的体重增加较慢，而长期作用尚不清楚。尽管基线体重，先前的SGA暴露，青春期状态和SGA类型已被建议作为缓和剂，但仍未阐明可能影响体重增加的因素。我们分析了利培酮和阿立哌唑在一项为期2年的观察性研究中的儿科门诊样本中引起的体重增加。
方法：我们在几个时间点评估他们的体重指数（BMI）-Z得分（年龄和性别校正并参考国家规范）。我们使用分层混合效应建模来设计BMI-Z轨迹，并观察了几个变量对确定它们的影响。
结果：该研究组由127名患者组成，平均为男性（79％），平均为12.6岁，接受利培酮（81％）和阿立哌唑（19％）治疗具有和不具有神经发育障碍的患者的破坏性行为症状。总体而言，BMI-Z初次访问时为1.2，最后一次访问时为1.4（无明显变化）。我们可以设计四个由体重决定的体重变化轨迹：药物（利培酮/阿立哌唑）和年龄状态（儿童/青少年）。该模型中未保留的其他因素，但可能是解释性的，包括先前的SGA治疗持续时间以及由于该观察性研究中的辍学而导致的逐步患者选择效应。利培酮治疗与儿童BMI-Z升高和青少年BMI-Z升高趋势相关。阿立哌唑治疗与BMI-Z显着增加有关，儿童中的BMI-Z高于青少年。结果可能是由于青少年以前接触药物的时间更长。
结论：利培酮和阿立哌唑的患儿体重增加的风险均比青少年高。青少年和长期吸毒的患者倾向于达到稳定的BMI-Z，尽管介于体重过多和肥胖之间。

BACKGROUND & AIMS: :Treatment of Alzheimer's disease sometimes uses combinations of drugs because dementia is frequently associated with behavioral symptoms. Risperidone and donepezil are both metabolized through cytochrome P450 2D6 and 3A4, raising the possibility of drug interactions with combination therapy. The objective of this study was to determine whether significant drug interactions occur with concomitant administration of donepezil and risperidone. In an open-label, three-way crossover study, 24 healthy men were randomly assigned to receive 0.5 mg of risperidone twice daily, 5 mg of donepezil once daily, or both drugs for 14 consecutive days, followed by a 21-day washout period. The treatment ratios of AUC and associated 90% confidence intervals (CIs) for risperidone active moiety, defined as risperidone plus 9-hydroxyrisperidone (ratio = 110.2%; 90% CI = 103.7-117.2), and for donepezil (ratio = 97.1%; 90% CI = 90.0-103.6) were within the 80% to 125% of bioequivalence range. The treatment ratios of Cmax and associated 90% CIs for risperidone active moiety (ratio = 114.6%; 90% CI = 107.0-122.8) and for donepezil (ratio = 96.1%; 90% CI = 90.0-102.6) were also within the bioequivalence range. Therefore, no significant pharmacokinetic differences occurred in either risperidone active moiety or donepezil when given alone or in combination. Adverse events (predominantly headache, nervousness, and somnolence) were minor and comparable for all treatment groups. The results indicate that no clinically meaningful drug interactions occurred between risperidone 1 mg daily and donepezil 5 mg daily at steady state, and therefore no dosage adjustment is required when both drugs are combined with the dosage regimen studied. Additional investigations are warranted to determine the potential for interactions in elderly patients with dementia who may eliminate risperidone and donepezil more slowly and thus be more vulnerable to clinical drug interactions than the young healthy subjects examined in this study.

背景与目标： ：阿尔茨海默氏病的治疗有时会结合使用药物，因为痴呆症经常与行为症状相关。利培酮和多奈哌齐均通过细胞色素P450 2D6和3A4代谢，增加了药物与联合疗法相互作用的可能性。这项研究的目的是确定在与多奈哌齐和利培酮同时给药时是否发生显着的药物相互作用。在一项开放式，三方交叉研究中，随机分配24名健康男性，使其每天连续两次接受0.5 mg利培酮，每天一次5 mg的多奈哌齐或两种药物连续14天，随后为期21天的清除期。定义为利培酮加9-羟基利培酮的比例的利培酮活性部分的AUC和相关的90％置信区间（CIs）的治疗比率（比率= 110.2％; 90％CI = 103.7-117.2）和多奈哌齐（比率= 97.1％; 90％CI = 90.0-103.6）在生物等效性的80％到125％之间。利培酮活性成分（比率= 114.6％; 90％CI = 107.0-122.8）和多奈哌齐（比率= 96.1％; 90％CI = 90.0-102.6）的Cmax和相关90％CI的治疗率也在生物等效性之内范围。因此，单独或组合使用时，利培酮活性成分或多奈哌齐均未发生明显的药代动力学差异。不良事件（主要是头痛，神经质和嗜睡）轻微，在所有治疗组中均具有可比性。结果表明，稳定状态下每天1mg利培酮和5mg每天多奈哌齐之间没有发生临床上有意义的药物相互作用，因此，当两种药物与所研究的剂量方案联合使用时，无需调整剂量。与本研究中检查的年轻健康受试者相比，有必要进行额外的研究以确定老年痴呆症患者的相互作用潜力，这些老年痴呆症患者可能较慢地消除利培酮和多奈哌齐，因此更容易受到临床药物相互作用的影响。

BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to assess the safety and efficacy of risperidone augmentation of lithium in preschool-onset bipolar disorder (BD) among youth who insufficiently respond to lithium monotherapy. METHOD:Thirty-eight subjects between the ages of 4 and 17 years (mean age = 11.37 +/- 3.8 years) with onset of BD in preschool years (manic or mixed episode) entered this 12-month trial. All subjects received lithium monotherapy. Patients who failed to adequately respond to lithium monotherapy after 8 weeks and those who relapsed after an initial response were given risperidone augmentation for up to 11 months. The Young Mania Rating Scale (YMRS) was the primary outcome measure. Response was defined as a > or =50% decrease from baseline. Additional data were collected on diagnostic comorbidity, family history, number of hospitalizations, perinatal risk factors, history of physical or sexual abuse, Child Depression Rating Scale-Revised (CDRS-R), Clinical Global Impression (CGI) scale for BD (CGI-BP), Children's Global Assessment Scale (C-GAS), and adverse medication effects. RESULTS:Of the 38 subjects treated with lithium monotherapy, 17 responded, whereas 21 required augmentation with risperidone. Response rate in the youths treated with lithium + risperidone was 85.7% (n = 18/21). Significant predictors of inadequate response to lithium monotherapy requiring augmentation were: (1) attention-deficit/hyperactivity disorder (ADHD), (2) severity at baseline, (3) history of sexual or physical abuse, and (4) preschool age. Combination treatment of lithium and risperidone was found to be safe and well tolerated. CONCLUSIONS:A substantial proportion of youth with a history of preschool-onset BD treated with lithium were either nonresponders or partial responders. Subsequent augmentation of lithium with risperidone in these cases was well tolerated and efficacious. Potential predictors of lithium nonresponse identified in this study may guide the choice of medications earlier in the treatment process.

背景与目标： 目的：本研究的目的是评估对锂单药治疗反应不佳的年轻人在学龄前发作的双相情感障碍（BD）中使用利培酮增强锂的安全性和有效性。
方法：38名年龄在4至17岁（平均年龄= 11.37 /-3.8岁），学龄前BD发作（躁狂或混合发作）的受试者参加了这个为期12个月的试验。所有受试者均接受锂单药治疗。在8周后对锂单药治疗没有充分反应的患者以及在初次反应后复发的患者给予利培酮增强治疗长达11个月。青年躁狂症评定量表（YMRS）是主要的结局指标。响应定义为与基线相比下降>或= 50％。收集了以下数据：诊断合并症，家族病史，住院次数，围产期危险因素，身体或性虐待史，修订的儿童抑郁量表（CDRS-R），BD的临床总体印象量表（CGI） BP），儿童全球评估量表（C-GAS）和药物不良反应。
结果：在接受锂单药治疗的38位受试者中，有17位有效，而21位需要使用利培酮进行增强。锂利培酮治疗的年轻人的缓解率为85.7％（n = 18/21）。对需要增加使用锂的单药治疗反应不足的重要预测因素包括：（1）注意缺陷/多动障碍（ADHD），（2）基线严重程度，（3）性或身体虐待史以及（4）学龄前儿童。锂和利培酮的联合治疗被发现是安全且耐受性良好的。
结论：相当一部分有锂治疗的学龄前性BD病史的青年是无反应者或部分反应者。在这些情况下，随后使用利培酮增加锂的耐受性和疗效良好。在这项研究中确定的锂无反应的潜在预测因素可能会在治疗过程的早期指导药物的选择。

BACKGROUND & AIMS: :Risperidone is metabolized to its active metabolite, 9-hydroxyrisperidone, mainly by the cytochrome P450 enzymes CYP2D6 and 3A4. Its antipsychotic effect is assumed to be related to the active moiety, that is, the sum of risperidone and 9-hydroxyrisperidone. Both risperidone and 9-hydroxyrisperidone are substrates of P-glycoprotein (P-gp), a transport protein involved in drug absorption, distribution, and elimination. The aim of the present study was to evaluate the influence of polymorphisms in genes encoding CYP3A5 and P-gp (ABCB1) on the steady-state plasma levels of risperidone, 9-hydroxyrisperidone, and the active moiety, taking CYP2D6 genotype status into account. Forty-six white patients with schizophrenia treated with risperidone (1-10 mg/d) in monotherapy for 4-6 weeks were genotyped, and their plasma concentrations of risperidone and 9-hydroxyrisperidone were measured. Dose-corrected plasma concentrations (C/D) of risperidone, 9-hydroxyrisperidone, and active moiety showed up to 68-, 9-, and 10-fold interindividual variation, respectively. Six patients carried 1 CYP3A5*1 allele and therefore were likely to express the CYP3A5 enzyme. The CYP3A5 genotype did not influence risperidone, 9-hydroxyrisperidone, or active moiety C/Ds. The CYP2D6 genotype in these 46 patients was again associated with risperidone C/D (P = 0.001) but not with 9-hydroxyrisperidone C/D or active moiety C/D, as previously shown by our group in 37 of these patients. Patients homozygous for the ABCB1 3435T/2677T/1236T haplotype had significantly lower C/Ds of 9-hydroxyrisperidone (P = 0.026) and active moiety (P = 0.028) than patients carrying other ABCB1 genotypes. In conclusion, our results confirmed the significant effect of CYP2D6 genotype on the steady-state plasma levels of risperidone and showed that ABCB1 polymorphisms have a moderate effect on those of 9-hydroxyrisperidone and the active moiety.

背景与目标： ：利培酮主要通过细胞色素P450酶CYP2D6和3A4代谢成其活性代谢物9-羟基利培酮。假定其抗精神病作用与活性部分有关，即利培酮和9-羟基利培酮的总和。利培酮和9-羟基利培酮都是P-糖蛋白（P-gp）的底物，P-gp是一种涉及药物吸收，分布和消除的转运蛋白。本研究的目的是在考虑CYP2D6基因型状态的情况下，评估CYP3A5和P-gp（ABCB1）编码基因多态性对利培酮，9-羟基利培酮和活性成分的稳态血浆水平的影响。对46例接受利培酮（1-10 mg / d）单一治疗4-6周的精神分裂症白人患者进行基因分型，并测定其血浆中利培酮和9-羟基利培酮的浓度。利培酮，9-羟基利培酮和活性部分的剂量校正血浆浓度（C / D）分别显示高达68倍，9倍和10倍的个体差异。 6名患者携带1个CYP3A5 * 1等位基因，因此可能表达CYP3A5酶。 CYP3A5基因型不影响利培酮，9-羟基利培酮或活性部分C / D。 CYP2D6基因型在这46例患者中再次与利培酮C / D相关（P = 0.001），但与9-羟基利培酮C / D或活性成分C / D不相关，正如我们小组中先前在这些患者中的37名所示。与携带其他ABCB1基因型的患者相比，纯合ABCB1 3435T / 2677T / 1236T单倍型的患者的9-羟基利培酮（C = 0.026）和活性部分（P = 0.028）的C / D显着降低。总之，我们的结果证实了CYP2D6基因型对利培酮的稳态血浆水平具有显着影响，并表明ABCB1多态性对9-羟基利培酮和活性成分的中度影响中等。