Howanitz E, Pardo M, Smelson D A, Engelhart C, Eisenstein N, Stern R G, Losonczy M F
Department of Psychiatry, VA New Jersey Health Care System, Lyons 07939, USA.
J Clin Psychiatry. 1999 Jan;60(1):41-4. doi: 10.4088/jcp.v60n0109.
There has been an absence of controlled studies focusing specifically on neuroleptic treatment in the elderly schizophrenic population. Therefore, we conducted a 12-week double-blind comparison study to assess the efficacy and tolerability of clozapine and chlorpromazine in a group of elderly inpatients with chronic schizophrenia.
Forty-two elderly DSM-IV schizophrenic veterans were randomly assigned to clozapine or chlorpromazine and assessed for efficacy at baseline and at termination with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions scale (CGI). Side effects were also monitored. Medications were titrated, on the basis of clinical response and side effects, to a maximum dose of 300 mg/day of clozapine or 600 mg/day of chlorpromazine.
The results suggest that both the chlorpromazine and clozapine groups improved their PANSS scores at termination compared with baseline, but the difference between the 2 groups was not statistically significant. The mean CGI scores reflecting severity of illness also demonstrated improvement in both groups over time. Both groups had similar incidences of side effects. One patient in each group had a life-threatening side effect. More patients taking clozapine had tachycardia and weight gain, while more chlorpromazine patients noted sedation.
We concluded that both clozapine and chlorpromazine are effective treatments for psychosis and behavioral disturbances in geriatric schizophrenia. Both agents had similar incidences of side effects. With careful monitoring and titration of dosage, both clozapine and chlorpromazine were fairly well tolerated in this population.
一直缺乏专门针对老年精神分裂症患者进行抗精神病药物治疗的对照研究。因此，我们开展了一项为期12周的双盲对照研究，以评估氯氮平和氯丙嗪对一组老年慢性精神分裂症住院患者的疗效和耐受性。
42名符合DSM-IV标准的老年精神分裂症退伍军人被随机分配至氯氮平组或氯丙嗪组，并在基线期和研究结束时使用阳性与阴性症状量表（PANSS）及临床总体印象量表（CGI）评估疗效。同时监测副作用。根据临床反应和副作用情况调整药物剂量，氯氮平最大剂量为300毫克/天，氯丙嗪最大剂量为600毫克/天。
结果表明，与基线期相比，氯氮平和氯丙嗪两组在研究结束时PANSS评分均有所改善，但两组间差异无统计学意义。反映疾病严重程度的平均CGI评分在两组中也随时间推移有所改善。两组副作用发生率相似。每组各有1例患者出现危及生命的副作用。服用氯氮平的患者心动过速和体重增加更为常见，而服用氯丙嗪的患者镇静作用更为明显。
我们得出结论，氯氮平和氯丙嗪均是治疗老年精神分裂症患者精神病性症状和行为障碍的有效药物。两种药物副作用发生率相似。通过仔细监测和调整剂量，氯氮平和氯丙嗪在该人群中耐受性良好。
