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Titolo:
Choosing the right dose of antipsychotics in schizophrenia - Lessons from neuroimaging studies
Autore:
Tauscher, J; Kapur, S;
Indirizzi:
Univ Vienna, Dept Gen Psychiat, A-1090 Vienna, Austria Univ Vienna Vienna Austria A-1090 t Gen Psychiat, A-1090 Vienna, Austria Univ Toronto, Ctr Addict & Mental Hlth, Schizophrenia PET Program, Toronto, ON, Canada Univ Toronto Toronto ON Canada ophrenia PET Program, Toronto, ON, Canada Univ Toronto, Ctr Addict & Mental Hlth, Schizophrenia & Continuing Care Program, Toronto, ON, Canada Univ Toronto Toronto ON Canada tinuing Care Program, Toronto, ON, Canada
Titolo Testata:
CNS DRUGS
fascicolo: 9, volume: 15, anno: 2001,
pagine: 671 - 678
SICI:
1172-7047(2001)15:9<671:CTRDOA>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
D-2 RECEPTOR OCCUPANCY; FIRST-EPISODE SCHIZOPHRENIA; PHOTON-EMISSION TOMOGRAPHY; I-123 IBZM SPECT; IN-VIVO; CLOZAPINE; HALOPERIDOL; OLANZAPINE; RISPERIDONE; QUETIAPINE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
43
Recensione:
Indirizzi per estratti:
Indirizzo: Tauscher, J Univ Vienna, Dept Gen Psychiat, Wahringer Gurtel 18-20, A-1090Vienna, Austria Univ Vienna Wahringer Gurtel 18-20 Vienna Austria A-1090 tria
Citazione:
J. Tauscher e S. Kapur, "Choosing the right dose of antipsychotics in schizophrenia - Lessons from neuroimaging studies", CNS DRUGS, 15(9), 2001, pp. 671-678

Abstract

Despite vast clinical experience with antipsychotics, there is no broad consensus on the doses of these substances that should be administered. Currently, most antipsychotics are administered empirically according to clinical dose-finding studies, in which arbitrarily selected doses were tested to find the 'most efficient' dose range in a patient population, with no regard for the molecular effects of the tested drug. Brain imaging studies using nuclear medical techniques, such as positron emission tomography (PET) or single photon emission computed tomography (SPECT), can now provide a rationale for doses, directly derived from the central effects of the drugs on neurotransmitter receptors measured in vivo. PETresults indicate that occupancy of at least 65% of dopamine D-2 receptors is needed for clinical response to antipsychotics, and that occupancy ratesexceeding 72 and 78% are associated with a high risk for elevation of prolactin levels and motor adverse effects, respectively. For example, clinicalstudies with haloperidol do not point to an advantage of dosages exceeding5 mg/day. The relevance of D-2 receptor occupancy for drug administration is also borne out by studies relating the effects of antipsychotics to their D-2 receptor occupancy in relevant animal models. Taken together, neuroimaging and clinical studies, as well as animal models, provide a rationale for the use of relatively low doses of typical antipsychotics and equivalent doses of novel antipsychotics. The lower risk of adverse effects with appropriate doses of antipsychotics may further enhancecompliance and outcome. This seems to be particularly important in individuals experiencing a first episode of schizophrenia, as they appear to be especially responsive to pharmacotherapy and quite sensitive to adverse effects.

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Documento generato il 20/06/19 alle ore 17:27:41