氯氮平治疗精神分裂症患者的强迫症状：一项病例系列研究。
Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study.
作者信息
Reznik I, Yavin I, Stryjer R, Spivak B, Gonen N, Strous R, Mester R, Weizman A, Kotler M
机构信息
Ness-Ziona Mental Health Center, Ness-Ziona, Israel.
出版信息
Pharmacopsychiatry. 2004 Mar;37(2):52-6. doi: 10.1055/s-2004-815525.
INTRODUCTION
Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others.
METHODS
The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology.
RESULTS
Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses.
DISCUSSION
Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors
引言
在相当一部分精神分裂症患者中观察到强迫症状。有一些报告描述了在氯氮平（CLZ）治疗下，既往存在的强迫症状新发或再次出现。然而，也有报告描述了氯氮平治疗对伴有强迫症状的精神分裂症患者有积极作用。似乎合并强迫症状在接受氯氮平治疗的难治性精神分裂症患者中很常见，并且很可能是其疾病的一个组成部分。这组精神分裂症患者治疗反应的复杂性质尚不清楚。氯氮平对强迫症状的影响可能各不相同，有证据表明一些患者症状改善，而另一些患者症状恶化。
方法
本病例系列研究描述了我们使用氯氮平作为单一药物（n = 10）或与5-羟色胺再摄取抑制剂联合使用（n = 5）治疗有明显强迫症状的精神分裂症患者的经验。
结果
对我们患者的临床特征以及迄今为止文献中的研究结果进行系统分析后，我们提出了一些可能预测对氯氮平治疗有反应的因素，这些因素适用于有明显强迫症状的难治性精神分裂症患者：1）在精神病性病程中开始出现强迫症状的精神分裂症患者需要且可能仅用氯氮平就能成功治疗；2）当强迫症状先于精神分裂症病程出现时，氯氮平单一疗法无效，甚至可能使强迫症状恶化；因此，应与特定的抗强迫药物联合治疗；3）在两组中，高剂量使用氯氮平时，氯氮平有明确的与剂量相关的促强迫影响。
讨论
需要在更大规模的伴有强迫症状的精神分裂症患者队列中进行进一步的对照研究，以证实我们的假设。OCD：强迫症；OCS：强迫症状；SRI：5-羟色胺再摄取抑制剂
Zotero 插件