Ciapparelli A, Dell'Osso L, Pini S, Chiavacci M C, Fenzi M, Cassano G B
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy.
J Clin Psychiatry. 2000 May;61(5):329-34. doi: 10.4088/jcp.v61n0502.
The aim of this study was to evaluate the 24-month response to clozapine in patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder.
Ninety-one psychotic patients with a principal DSM-III-R diagnosis of schizophrenia (N = 31), schizoaffective disorder (N = 26), or bipolar disorder with psychotic features (N = 34) were treated naturalistically with clozapine at flexible dosages over a 24-month period. Improvement was assessed by the 18-item Brief Psychiatric Rating Scale and the Clinical Global Impressions-Severity of Illness scale.
All patients showed significant improvement 24 months from intake (p < .001). Such an improvement was significantly greater among patients with schizoaffective disorder or bipolar disorder than in patients with schizophrenia (p < .05). The presence of suicidal ideation at intake predicted greater improvement at endpoint.
Clozapine appears to be effective and relatively well tolerated in acute and long-term treatment of patients with psychotic bipolar disorder or schizoaffective disorder who have not responded to conventional pharmacotherapies.
本研究旨在评估氯氮平对精神分裂症、分裂情感性障碍或伴有精神病性症状的双相情感障碍患者的24个月疗效。
91例主要依据《精神疾病诊断与统计手册第三版修订版》（DSM-III-R）诊断为精神分裂症（N = 31）、分裂情感性障碍（N = 26）或伴有精神病性特征的双相情感障碍（N = 34）的精神病患者，在24个月内接受氯氮平灵活剂量的自然疗法治疗。通过18项简明精神病评定量表和临床总体印象-疾病严重程度量表评估改善情况。
所有患者自开始治疗24个月后均有显著改善（p <.001）。分裂情感性障碍或双相情感障碍患者的改善程度显著大于精神分裂症患者（p <.05）。治疗开始时存在自杀观念预示着终点时改善更大。
对于对传统药物治疗无反应的伴有精神病性症状的双相情感障碍或分裂情感性障碍患者，氯氮平在急性和长期治疗中似乎有效且耐受性相对良好。
