NHS Health Trust n. 10 Veneto Orientale, Unit of Psychiatry of Portogruaro, Via Forlanini 2, 30026 Portogruaro, Venezia, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jun 1;35(4):1112-6. doi: 10.1016/j.pnpbp.2011.03.011. Epub 2011 Apr 5.
Although clozapine proved effective in treating 30-50% of the cases of resistant schizophrenia, its clinical use is hampered by significant side effects. To overcome this problem, augmentation with other atypical antipsychotics has been attempted, with conflicting results. A clozapine-aripiprazole combination showed interesting properties, due to the favourable complementary pharmacodynamic receptor profile and to the negligible metabolic interactions. In this retrospective case series, we investigated the change in BPRS scores and metabolic features like BMI, fasting glucose, total and LDL cholesterol, triglycerides, functional outcome HoNOS Rome and PSP scores after aripiprazole augmentation in 16 persons with treatment-resistant schizophrenia who were already treated with clozapine. The results demonstrated a statistically significant improvement in metabolic indices, psychopathology and functional outcome measures from baseline to endpoint (6weeks) after augmentation with aripiprazole. Statistically significant correlations were observed between psychopathological and behavioural measures at baseline and at endpoint. Linear regression analysis defined a tripartite model, in which item HoNOS Rome 11, measuring autonomy in everyday life, explained nearly half of functional outcome PSP score predictive variance, together with BPRS total psychopathology score and HoNOS Rome total social functioning score. Adequately conducted randomised double-blind studies should provide further specific data highlighting the role of a clozapine-aripiprazole combination in improving functional outcome of persons with treatment-resistant schizophrenia.
虽然氯氮平在治疗 30-50%的耐药性精神分裂症病例方面证明是有效的，但它的临床应用受到严重副作用的阻碍。为了克服这个问题，已经尝试了用其他非典型抗精神病药物来增效，结果却存在冲突。氯氮平-阿立哌唑联合具有有趣的特性，这归因于有利的互补药效受体特征和可忽略的代谢相互作用。在这项回顾性病例系列研究中，我们调查了在已经接受氯氮平治疗的 16 名治疗抵抗性精神分裂症患者中，阿立哌唑增效后 BPRS 评分和代谢特征（如 BMI、空腹血糖、总胆固醇和 LDL 胆固醇、甘油三酯）、功能性结果 HoNOS Rome 和 PSP 评分的变化。结果表明，在增效阿立哌唑后，代谢指标、精神病理学和功能结果测量从基线到终点（6 周）有统计学意义的改善。在基线和终点观察到精神病理学和行为测量之间存在统计学显著相关性。线性回归分析定义了一个三分模型，其中日常生活自主性测量的 HoNOS Rome 11 项几乎解释了功能结果 PSP 评分预测方差的一半，同时还包括 BPRS 总精神病理学评分和 HoNOS Rome 总社会功能评分。适当进行的随机双盲研究应该提供进一步的具体数据，突出氯氮平-阿立哌唑联合在改善治疗抵抗性精神分裂症患者的功能结果方面的作用。
