Antonacci D J, de Groot C M
Department of Psychiatric Medicine, East Carolina University School of Medicine, Greenville, NC 27858, USA.
J Clin Psychiatry. 2000 Jan;61(1):22-5. doi: 10.4088/jcp.v61n0106.
There is a paucity of data on the use of clozapine in patients with mental retardation and comorbid psychiatric illness. The authors describe their recent clinical experience using clozapine in treatment-refractory patients with mental retardation and severe psychiatric illness.
A retrospective review was performed on the records of all patients admitted to a university-affiliated, specialized inpatient psychiatry service who were selected for clozapine therapy from March 1994 through December 1997 (N = 33). Patients had DSM-IV diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, or psychotic disorder NOS and were considered treatment resistant. All had deficits in functioning well beyond those expected for their degree of cognitive deficits and adaptive delays.
Of 33 initial patients, 26 remained on clozapine therapy for a follow-up duration of 5 to 48 months (mean = 24.8 months). Evaluation at follow-up revealed Clinical Global Impressions-Improvement (CGI-I) scores from 1 to 4 with a mean +/- SD improvement of 2.0 +/- 0.8 (much improved). The mean +/- SD rating of the CGI-Efficacy Index was 5 +/- 2.6 (decided improvement and partial remission of symptoms with no interference from side effects). The 6 patients who were not maintained on clozapine therapy over the study period did not significantly differ from the clozapine group in gender, race, age, side effects, or diagnosis. One patient was lost to follow-up. Side effects were mild and transient with constipation being the most common (N = 10). There were no significant cardiovascular side effects and no seizures. No patients discontinued treatment due to agranulocytosis.
The current investigation lends support to the conclusion that clozapine appears to be safe, efficacious, and well tolerated in individuals with mental retardation and comorbid psychiatric illness.
关于氯氮平在智力发育迟缓合并精神疾病患者中的应用数据匮乏。作者描述了他们近期使用氯氮平治疗难治性智力发育迟缓及严重精神疾病患者的临床经验。
对1994年3月至1997年12月期间被选入氯氮平治疗的所有入住大学附属专业住院精神科的患者记录进行回顾性研究（N = 33）。患者符合《精神疾病诊断与统计手册》第四版（DSM-IV）中精神分裂症、分裂情感性障碍、双相情感障碍、妄想性障碍或未特定的精神障碍诊断标准，且被认为治疗抵抗。所有患者的功能缺陷程度远超过其认知缺陷和适应性延迟所预期的程度。
33例初始患者中，26例持续接受氯氮平治疗，随访时间为5至48个月（平均 = 24.8个月）。随访评估显示临床总体印象改善量表（CGI-I）评分在1至4分之间，平均改善±标准差为2.0±0.8（显著改善）。CGI-疗效指数的平均±标准差评分为5±2.6（症状有决定性改善且部分缓解，无副作用干扰）。在研究期间未持续接受氯氮平治疗的6例患者在性别、种族、年龄、副作用或诊断方面与氯氮平组无显著差异。1例患者失访。副作用轻微且短暂，便秘最为常见（N = 10）。无显著心血管副作用，无癫痫发作。无患者因粒细胞缺乏症停药。
当前研究支持以下结论：氯氮平在智力发育迟缓合并精神疾病患者中似乎安全有效且耐受性良好。
