Umbricht Daniel S, Wirshing William C, Wirshing Donna A, McMeniman Marjorie, Schooler Nina R, Marder Stephen R, Kane John M
Department of Psychiatric Research, Psychiatric University Hospital, Zurich, Switzerland.
J Clin Psychiatry. 2002 May;63(5):420-4. doi: 10.4088/jcp.v63n0508.
Despite the advent of new atypical antipsychotics, clozapine remains an important option in the treatment of patients with poor response to conventional antipsychotics. Clinicians would be well served if clinical characteristics could be identified that predict a favorable response to clozapine. A few studies addressing this issue have reported inconsistent results.
The association of clinical characteristics with a sustained response was investigated in 37 partially treatment-refractory outpatients with a DSM-III-R diagnosis of chronic schizophrenia who had been assigned to clozapine treatment in a double-blind, haloperidol-controlled, long-term (29-week) study of clozapine. Response was defined as a 20% decrease of the Brief Psychiatric Rating Scale (BPRS) psychosis factor score sustained over 2 consecutive ratings. Differences between responders and nonresponders with regard to selected baseline variables were analyzed with t tests and chi2 tests. In addition, Cox regression analyses were performed to identify variables that best predicted a response to clozapine treatment.
Clozapine responders were rated as less severely ill, showed a lesser degree of negative symptoms, and demonstrated fewer extrapyramidal side effects at baseline as compared with nonresponders. In addition, higher BPRS total scores--after controlling for the effects of the other variables--were associated with a response.
In a cohort of partially treatment-refractory outpatients, a favorable response to clozapine was associated with characteristics describing less severely ill patients. The history of patients did not affect their response to clozapine.
尽管新型非典型抗精神病药物已经问世，但氯氮平对于传统抗精神病药物反应不佳的患者而言，仍然是一种重要的治疗选择。如果能够识别出可预测对氯氮平有良好反应的临床特征，将对临床医生大有帮助。针对这一问题的一些研究报告的结果并不一致。
在一项为期29周的氯氮平双盲、氟哌啶醇对照的长期研究中，对37例符合DSM-III-R诊断标准的慢性精神分裂症部分治疗抵抗门诊患者进行氯氮平治疗，研究临床特征与持续反应之间的关联。反应定义为简明精神病评定量表（BPRS）精神病因子得分在连续2次评定中持续下降20%。采用t检验和卡方检验分析反应者和无反应者在选定基线变量方面的差异。此外，进行Cox回归分析以确定最能预测对氯氮平治疗有反应的变量。
与无反应者相比，氯氮平反应者在基线时病情评定较轻，阴性症状程度较轻，锥体外系副作用较少。此外，在控制其他变量的影响后，较高的BPRS总分与反应相关。
在一组部分治疗抵抗的门诊患者中，对氯氮平的良好反应与病情较轻患者的特征相关。患者的病史不影响其对氯氮平的反应。
