Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia — a retrospective study of 387 patients
Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia — a retrospective study of 387 patients
复制标题
氯氮平治疗精神分裂症和迟发性运动障碍的疗效和不良反应——387例患者的回顾性研究
作者：
Dieter Naber;M. Leppig;R. Grohmann;H. Hippius
对387例住院患者（精神分裂症284例，迟发性运动障碍48例）的病历进行分析，评价氯氮平的疗效和不良反应。这些患者以前接受过两到四种其他精神抑制剂的治疗，并且要么对治疗有抵抗力，要么有严重的副作用。精神分裂症患者用氯氮平治疗，疗程48±35（TD 49±40）d，剂量189±119（TD 220±176）mg。4%的患者病情恶化，13%无变化，38%轻微改善，42%显著改善，3%症状几乎完全减轻。在TD中，44%显示出明显的改善，但只有17%的药物优于以前的精神抑制剂上级。56%的患者出现不良反应。最常见的是镇静（17%）、EEG改变（16%）、肝酶升高（8%）、低血压（7%）、多涎（5%）、发热（5%）、ECG改变（4%）、心动过速（3%）、胃肠道（3%）和谵妄状态（2%）。逐渐增加剂量似乎可以大大降低某些副作用的发生率。5.9%的患者因严重副作用而停药。这些患者均未发生粒细胞缺乏症等严重并发症。仅脑电图改变与氯氮平剂量显著相关（P<0.0005）。在出院时，大多数患者继续接受氯氮平;只有22%（TD 20%）的患者被另一种精神抑制剂取代。因此，在大多数阴性选择的患者中，氯氮平治疗的获益/风险比似乎令人满意。尽管如此，强烈建议逐渐增加剂量并仔细控制血液学和其他变量。
Medical charts of 387 in-patients (schizophrenia n=284, tardive dyskinesia, TD, n=48), were analyzed to evaluate efficacy and adverse effects of clozapine. These patients were previously treated with between two and four other neuroleptics and were either therapy resistant or had severe side effects. Schizophrenic patients were treated with clozapine for 48±35 (TD 49±40) days, dosage was 189±119 (TD 220±176) mg. Four per cent showed worsening, 13% no change, 38% slight improvement, 42% marked improvement and 3% nearly total reduction of symptoms. In TD, 44% showed marked improvement, but only in 17% the drug was superior to previous neuroleptics. Adverse effects occurred in 56% of patients. Most frequent were sedation (17%), EEG alterations (16%), increase of liver enzymes (8%), hypotension (7%), hypersalivation (5%), fever (5%), ECG alterations (4%), tachycardia (3%), gastro-intestinal (3%) and delirious states (2%). A gradual increase in dosage seems to considerably reduce the incidence of some side effects. Clozapine treatment had to be discontinued because of severe side effects in 5.9%. In none of these patients did serious complications such as agranulocytosis occur. Only EEG alterations were significantly related to clozapine dosage (P<0.0005). At dismissal, most patients continued to receive clozapine; only in 22% (TD 20%) was it replaced by another neuroleptic. Thus, the ratio benefit/risk of clozapine treatment seems to be satisfactory in most of the negatively selected patients. Never-theless, a gradual increase in dosage and careful control of hematological and other variables is highly recommended.
影响因子：
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作者：
J. Kane;G. Honigfeld;J. Singer;H. Meltzer
通讯作者：
J. Kane;G. Honigfeld;J. Singer;H. Meltzer