患者,诊断为偏执型的Sc，服用杨森的利培酮7mg/d，幻觉和妄想消失了，出现了强迫思维及行为，总是反复想事，知道没有必要但是控制不了，怕自己的病刚好又添了新的症状，情绪很不好，利培酮应用８周我将利培酮逐渐减量，逐渐增加奥氮平的剂量，目前是奥氮平（欧兰宁）35mg/d和利培酮３.５mg/d，强迫症状消失了，我没有用任何的抗抑郁药，因为觉得应该是利培酮的副作用，自己觉得孩子的病挺重的，２个月才基本症状控制住，偶尔有药源性焦虑的时候给点安坦．目前打算把利培酮逐渐减下来．
我查了一下知网，相关的论文很少，有一篇论文＜＜利培酮致不良反应８例报告＞＞里面有１例引起强迫症状的个案，给的解释是利培酮阻断５－ＨＴ２Ａ和α2受体等引起单胺释放增加，增加的多巴胺诱发强迫症状．
想问问大家有没有这方面的文献，因为英语水平有限，还是想看看关于这方面有没有什么论述，谢谢大家帮忙！
简单查了下文献，可能找到的不多
国外文献也有的：
1、（利培酮引起强迫症状的个案报告）A Case Report of Risperidone-Induced Obsessive-Compulsive Symptoms
Alzaid, Khalid MD; Jones, Barry D. MD
K Alzaid… - Journal of clinical psychopharmacology, 1997 - journals.lww.com
2、（利培酮通过拮抗五羟色胺的机制加重？/导致？强迫症状）
Risperidone and obsessive-compulsive symptoms.
Remington, Gary; Adams, Martha
Journal of Clinical Psychopharmacology, Vol 14(5), Oct 1994, 358-359.
Abstract：
The case of a 56-yr-old male with obsessive-compulsive symptoms who was treated with the neuroleptic risperidone illustrates possible adverse effects (e.g., a return of compulsive behaviors) related to serotonergic antagonism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
也有相应的治疗措施：
（利培酮引起的强迫症状用舍曲林治疗）
Am J Psychiatry. 1997 Apr;154(4):582.
Treatment of risperidone-induced obsessive-compulsive symptoms with sertraline.
Dodt JE, Byerly MJ, Cuadros C, Christensen RC.
还有一篇：6例报告
Risperidone-induced obsessive-compulsive symptoms: a series of six cases
B Alevizos, L Lykouras, IM Zervas… - Journal of clinical …, 2002 - journals.lww.com
Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT 2 and D 2
receptors. Open-label reports and one controlled study suggest that risperidone addition is effective
in patients with obsessive-compulsive disorder refractory to treatment with serotonin ...
被引用次数：63 - 相关文章 - 所有 6 个版本
Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT2 and D2 receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced de novo obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.
利培酮导致/加重强迫症状的机制目前不明，可能与剂量有关，并且通过影响五羟色胺-多巴胺系统发挥作用。
