Centorrino F, Albert M J, Drago-Ferrante G, Koukopoulos A E, Berry J M, Baldessarini R J
Department of Psychiatry & Neuroscience Program, Harvard Medical School, Boston, MA, USA.
Pharmacopsychiatry. 2003 Jul;36(4):156-60. doi: 10.1055/s-2003-41201.
Incidence and risk factors for delirium during clozapine treatment require further clarification.
We used computerized pharmacy records to identify all adult psychiatric inpatients treated with clozapine (1995-96), reviewed their medical records to score incidence and severity of delirium, and tested associations with potential risk factors.
Subjects (n = 139) were 72 women and 67 men, aged 40.8 +/- 12.1 years, hospitalized for 24.9 +/- 23.3 days, and given clozapine, gradually increased to an average daily dose of 282 +/- 203 mg (3.45 +/- 2.45 mg/kg) for 18.9 +/- 16.4 days. Delirium was diagnosed in 14 (10.1 % incidence, or 1.48 cases/person-years of exposure); 71.4 % of cases were moderate or severe. Associated factors were co-treatment with other centrally antimuscarinic agents, poor clinical outcome, older age, and longer hospitalization (by 17.5 days, increasing cost); sex, diagnosis or medical co-morbidity, and daily clozapine dose, which fell with age, were unrelated.
Delirium was found in 10 % of clozapine-treated inpatients, particularly in older patients exposed to other central anticholinergics. Delirium was inconsistently recognized clinically in milder cases and was associated with increased length-of-stay and higher costs, and inferior clinical outcome.
氯氮平治疗期间谵妄的发生率及危险因素尚需进一步明确。
我们利用计算机化药房记录识别出所有在1995 - 1996年接受氯氮平治疗的成年精神科住院患者，查阅他们的病历以对谵妄的发生率和严重程度进行评分，并检测其与潜在危险因素的关联。
受试者（n = 139）中，女性72例，男性67例，年龄40.8±12.1岁，住院24.9±23.3天，服用氯氮平，剂量逐渐增加至平均每日282±203 mg（3.45±2.45 mg/kg），共18.9±16.4天。14例（发生率10.1%，即每暴露人年1.48例）被诊断为谵妄；71.4%的病例为中度或重度。相关因素包括与其他中枢抗胆碱能药物联合治疗、临床结局不佳、年龄较大及住院时间较长（延长17.5天，费用增加）；性别、诊断或合并躯体疾病以及随年龄下降的氯氮平每日剂量与之无关。
在接受氯氮平治疗的住院患者中，10%出现谵妄，尤其在使用其他中枢抗胆碱能药物的老年患者中。谵妄在较轻病例中临床识别不一致，且与住院时间延长、费用增加及较差的临床结局相关。
