Dursun S M, Szemis A, Andrews H, Whitaker P, Reveley M A
Department of Psychiatry, Faculty of Medicine, University of Leicester, England.
J Psychiatry Neurosci. 2000 Sep;25(4):347-52.
To compare the efficacy of clozapine with typical antipsychotic drugs in controlling impulsivity and to explore the possible correlation of impulsivity with plasma 5-hydroxytryptamine (5-HT) levels, plasma 5-hydroxyindoleacetic acid (5-HIAA) levels and plasma 5-HT turnover.
Prospective, cross-sectional study open to medication and blinded to biochemical analyses.
Healthy control subjects (n = 24) and 46 inpatients and outpatients meeting the DSM-IV criteria for schizophrenia; 20 were being treated with clozapine and 26 were taking typical antipsychotic drugs.
All psychotropic drugs other than clozapine or typical antipsychotic drugs were discontinued for at least 5 days and subjects fasted overnight before they were assessed.
Coccaro Impulsivity Scale scores, plasma 5-HT levels, 5-HIAA levels and 5-HT turnover.
Patients treated with clozapine and those treated with typical antipsychotics had significantly higher impulsivity scores than the control group, and the mean impulsivity score of the typical antipsychotic group was significantly higher than that of patients treated with clozapine. The mean concentration of 5-HT of the typical antipsychotic group was significantly lower than that of the control group and patients treated with clozapine; however, mean plasma levels of 5-HIAA were significantly higher for the clozapine group than the other 2 groups. 5-HT turnover was significantly higher for the 2 drug-treatment groups than for the control group.
These results suggest that treatment with clozapine should be considered for patients with schizophrenia who are impulsive and aggressive.
比较氯氮平与典型抗精神病药物在控制冲动方面的疗效，并探讨冲动与血浆5-羟色胺（5-HT）水平、血浆5-羟吲哚乙酸（5-HIAA）水平及血浆5-HT周转率之间可能存在的相关性。
前瞻性横断面研究，对药物治疗开放，对生化分析设盲。
健康对照者（n = 24）以及46例符合精神疾病诊断与统计手册第四版（DSM-IV）精神分裂症标准的住院和门诊患者；20例接受氯氮平治疗，26例服用典型抗精神病药物。
除氯氮平或典型抗精神病药物外，所有精神药物停用至少5天，且受试者在接受评估前禁食过夜。
科卡罗冲动量表评分、血浆5-HT水平、5-HIAA水平及5-HT周转率。
氯氮平治疗组和典型抗精神病药物治疗组患者的冲动评分显著高于对照组，且典型抗精神病药物组的平均冲动评分显著高于氯氮平治疗组患者。典型抗精神病药物组的5-HT平均浓度显著低于对照组和氯氮平治疗组患者；然而，氯氮平组的5-HIAA平均血浆水平显著高于其他两组。两个药物治疗组患者的5-HT周转率显著高于对照组。
这些结果表明，对于有冲动和攻击行为的精神分裂症患者，应考虑使用氯氮平进行治疗。
