Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.
Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.
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DOI：
10.1055/s-2004-815525
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发表时间：
2004-03
影响因子：
4.3
通讯作者：
I. Reznik;I. Yavin;R. Stryjer;B. Spivak;N. Gonen;R. Strous;R. Mester;Abraham Weizman;M. Kotler
中科院分区：
文献类型：
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作者：
I. Reznik;I. Yavin;R. Stryjer;B. Spivak;N. Gonen;R. Strous;R. Mester;Abraham Weizman;M. Kotler
引言强迫症（OC）症状已观察到相当大比例的精神分裂症患者。有一些报告描述了氯氮平（CLZ）治疗下原有OC症状的新发或复发。然而，也有报道描述了CLZ治疗OC精神分裂症患者的积极作用。似乎共病OC症状在CLZ治疗的难治性精神分裂症患者中很常见，并且可能是其疾病的组成部分。这组精神分裂症患者治疗反应的复杂性尚不清楚。CLZ对OC症状的影响可能各不相同，有证据表明某些症状有所改善，而其他症状则有所恶化。方法：本病例系列研究描述了我们的经验，CLZ作为一个单一的代理（n = 10）或联合5-羟色胺再摄取抑制剂（n = 5），在精神分裂症患者突出的OC代谢。结果通过对患者临床特征的系统分析，结合文献资料，我们提出了一些可能预测具有明显OC症状的难治性精神分裂症患者对CLZ治疗反应的因素：1）在精神病过程中开始表现OC症状的精神分裂症患者需要并且可能单独用CLZ治疗成功;（2）当强迫症发生在精神分裂症发展之前时，CLZ单药治疗无效，甚至可能加重强迫症症状;因此，应与特定的抗强迫药物联合治疗;（3）在两组中，当给予大剂量CLZ时，都存在明确的剂量相关的促强迫作用。讨论在一个更大的OC精神分裂症患者队列的进一步对照研究，需要证实我们的假设。OCD：强迫症OCS：强迫症状SRI：血清素再摄取抑制剂
INTRODUCTION Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others. METHODS The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology. RESULTS Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses. DISCUSSION Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors