Sa Antonio R, Hounie Ana G, Sampaio Aline S, Arrais Jony, Miguel Euripedes C, Elkis Helio
Department and Institute of Psychiatry, Clinical Hospital, Faculty of Medicine, University of São Paulo, Brazil.
Compr Psychiatry. 2009 Sep-Oct;50(5):437-42. doi: 10.1016/j.comppsych.2008.11.005. Epub 2009 Jan 15.
We conducted a cross-sectional study to compare the prevalence and severity of obsessive-compulsive symptoms (OCSs) and obsessive-compulsive disorder (OCD) in patients with schizophrenia treated with clozapine or haloperidol. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders-patient edition was used to diagnose schizophrenia and OCD. Sixty subjects, 40 of them using clozapine and 20 using haloperidol, completed the Yale-Brown Obsessive-Compulsive Scale, the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression. The prevalence of OCD in patients taking clozapine was 20%, whereas the prevalence of patients taking haloperidol was 10%, although this difference was not statistically significant (P = .540). However, patients using clozapine showed higher severity of OCSs than patients using haloperidol (P = .027) did. When schizophrenia patients were divided according to the presence or absence of OCD or OCSs, patients with schizophrenia and OCD or OCSs showed higher severity of schizophrenia symptoms when compared to those with schizophrenia without OCD and OCSs (P = .002). A PANSS total score higher than 70 and the use of antidepressants were predictors of the presence of OCSs or OCD. Schizophrenia patients taking clozapine had higher severity scores both in obsessive-compulsive and schizophrenia rating scales. These results may support an association between the exacerbation of obsessive-compulsive phenomena and the use of clozapine.
我们开展了一项横断面研究，以比较接受氯氮平或氟哌啶醇治疗的精神分裂症患者中强迫症状（OCS）及强迫症（OCD）的患病率和严重程度。采用《精神障碍诊断与统计手册》第四版轴I障碍患者版结构化临床访谈来诊断精神分裂症和强迫症。60名受试者完成了耶鲁-布朗强迫量表、阳性和阴性症状量表（PANSS）以及临床总体印象量表，其中40人使用氯氮平，20人使用氟哌啶醇。服用氯氮平患者的强迫症患病率为20%，而服用氟哌啶醇患者的患病率为10%，尽管这一差异无统计学意义（P = 0.540）。然而，使用氯氮平的患者强迫症状严重程度高于使用氟哌啶醇的患者（P = 0.027）。当根据是否存在强迫症或强迫症状对精神分裂症患者进行划分时，与无强迫症和强迫症状的精神分裂症患者相比，患有强迫症或强迫症状的精神分裂症患者精神分裂症症状严重程度更高（P = 0.002）。PANSS总分高于70分及使用抗抑郁药是强迫症状或强迫症存在的预测因素。服用氯氮平的精神分裂症患者在强迫及精神分裂症评定量表上的严重程度得分均更高。这些结果可能支持强迫现象加重与氯氮平使用之间存在关联。
