The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation
The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation
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DOI：
10.4088/jcp.v60n1203
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发表时间：
1999-12-01
影响因子：
5.3
通讯作者：
Pazzagli, A
中科院分区：
文献类型：
--
作者：
Pallanti, S;Quercioli, L;Pazzagli, A
背景：社交恐惧症的潜在神经化学基础尚未得到充分解释，但有提示血清素能和多巴胺能功能障碍。据报道，非典型抗精神病药氯氮平可引起焦虑症状，可能是由于其对血清素能通路的影响。我们报告12例精神分裂症患者在氯氮平治疗期间出现社交恐惧症。方法：采用DSM-III-R、患者版、阴性症状评估量表、阳性症状评估量表、Liebowitz社交恐惧症量表和简易精神病学评定量表对患者进行评估。他们在氯氮平和氟西汀联合治疗12周后重新评估。结果：在12例患者中，有8例患者在服用氟西汀辅助治疗后症状得到缓解（Liebowitz社交恐惧症量表评分降低35%以上）。结论：从神经化学机制和认知适应的角度讨论了数据，这些数据可以解释氯氮平治疗的精神分裂症患者在精神病症状缓解期间出现焦虑谱系障碍（如社交恐惧症）。
Background: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment.Method: Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine.Results: In 8 of the 12 cases, symptoms responded (greater than or equal to 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive regimen of fluoxetine.Conclusion: Data are discussed in light of neurochemical mechanisms and cognitive adaptations that could explain the onset of anxiety spectrum disorders (such as social phobia) in clozapine-treated schizophrenic subjects during remission of psychotic symptoms.