Jalenques I, Coudert A J
Service de Psychiatrie A, Centre Médico-Psychologique, CHU Saint-Jacques, Clermont-Ferrand, France.
Acta Psychiatr Belg. 1992;92(6):323-38.
Clozapine, a dibenzodiazepine derivative, has potent antipsychotic activity; but bone marrow suppression resulting in agranulocytosis has been associated with clozapine treatment and has restricted the administration of this drug to treatment-resistant schizophrenic patients. This report describes preliminary results of an open prospective study of the effects of clozapine on symptomatology and social function in 16 treatment-resistant schizophrenic patients. Authors prospectively followed up for 18 months 16 DSM III-R schizophrenic patients who had failed to respond to various neuroleptics (n: 7.2 +/- 2.8); when clozapine treatment was initiated, the mean duration of the illness was 14.2 (+/- 6.7) years. Total BPRS, BPRS "positive" and "negative" symptoms scores were used for evaluation. Social integration and side effects were also studied. 14 of 16 patients are still receiving clozapine; 1 out of 14 patients has a more than 60% decrease in total BPRS, 11 out of 14 have 30 to 60% decrease in total BPRS and 2 out of 14 have less than 30% decrease in total BPRS. Improvements in both total and positive symptoms BPRS scores were observed within the first month of treatment (p < 0.001); improvement in negative symptoms was noted within the third month (p < 0.02). At the end of the follow up period, 43% of patients showed marked improvement in family life and 21% found a job during the study. Beyond noteworthy improvement of clinical symptoms in these patients who presented with severe schizophrenia, clozapine also significantly reduced the use of concomitant medication. Side effects are studied but none required treatment disruption; neurological side effects were less reported than with usual neuroleptics. It is concluded that clozapine offers particular benefits for some treatment-resistant schizophrenic patients; however the increased comparative risk requires a restricted use of clozapine to selected patients.
氯氮平是一种二苯并二氮卓衍生物，具有强效抗精神病活性；但氯氮平治疗与导致粒细胞缺乏症的骨髓抑制有关，这限制了该药物仅用于治疗难治性精神分裂症患者。本报告描述了一项开放性前瞻性研究的初步结果，该研究旨在观察氯氮平对16例难治性精神分裂症患者症状学和社会功能的影响。作者对16例DSM III-R精神分裂症患者进行了为期18个月的前瞻性随访，这些患者对各种抗精神病药物均无反应（平均剂量：7.2±2.8）；开始使用氯氮平时，平均病程为14.2（±6.7）年。采用简明精神病评定量表（BPRS）总分、BPRS“阳性”和“阴性”症状评分进行评估。同时研究了社会融合情况和副作用。16例患者中有14例仍在服用氯氮平；14例患者中有1例BPRS总分下降超过60%，11例下降30%至60%，2例下降不到30%。治疗第一个月内，BPRS总分及阳性症状评分均有改善（p<0.001）；第三个月时阴性症状有所改善（p<0.02）。随访期末，43%的患者家庭生活有显著改善，21%的患者在研究期间找到了工作。除了这些严重精神分裂症患者临床症状有明显改善外，氯氮平还显著减少了合并用药的使用。对副作用进行了研究，但无一例需要中断治疗；与常用抗精神病药物相比，神经方面的副作用报告较少。结论是氯氮平对某些难治性精神分裂症患者有特殊益处；然而，相对风险增加需要将氯氮平的使用限制在特定患者中。
