Lerma-Carrillo Iván, Molina Juan D, Cuevas-Durán Teresa, González-Parra Silvia, Blasco-Fontecilla Hilario, Andrade-Rosa Cristina, López-Muñoz Francisco, Alamo Cecilio
Acute Inpatients Unit, Dr. R. Lafora Psychiatric Hospital, Madrid, Spain.
Clin Neuropharmacol. 2007 Mar-Apr;30(2):114-21. doi: 10.1097/01.wnf.0000240947.51994.96.
Long-term studies show that 47% to 63% of schizophrenic patients treated with clozapine fail to respond after 12 years of treatment. Such high rates of resistance justify the growing interest in therapeutic strategies based on enhancing the effect of clozapine with other antipsychotics. The combination of clozapine and risperidone in the treatment of partial responders to clozapine has been one of those receiving most interest from research.
The present work reports the case of a 26-year-old man, diagnosed with schizophrenia who, after treatment with clozapine at appropriate doses over 12 weeks without observable response, showed a marked and sustained improvement after the addition of risperidone to the clozapine treatment. We also present a detailed review of publications related to the therapeutic combination of clozapine and risperidone in clozapine-resistant schizophrenia.
Despite the contradictory nature of the published data, our results are in support of other work reporting that treatment with a combination of clozapine and risperidone, apart from being well tolerated, may constitute an effective alternative in this type of patient. Nevertheless, there is a need for further, controlled studies, with larger samples, with a view to drawing definitive conclusions and making specific recommendations.
长期研究表明，接受氯氮平治疗的精神分裂症患者中有47%至63%在治疗12年后无反应。如此高的耐药率使得基于增强氯氮平与其他抗精神病药物联合疗效的治疗策略越来越受到关注。氯氮平与利培酮联合用于治疗对氯氮平部分反应者一直是研究中最受关注的领域之一。
本研究报告了一名26岁男性精神分裂症患者的病例，该患者在以适当剂量接受氯氮平治疗12周后无明显反应，在氯氮平治疗中加用利培酮后症状显著且持续改善。我们还详细综述了与氯氮平联合利培酮治疗氯氮平难治性精神分裂症相关的文献。
尽管已发表的数据存在矛盾，但我们的结果支持其他研究报告，即氯氮平与利培酮联合治疗，除耐受性良好外，可能是这类患者的一种有效替代方案。然而，仍需要进一步开展更大样本量的对照研究，以便得出明确结论并提出具体建议。
