Geha Mental Health Center, Petach Tikva, Israel.
Int Clin Psychopharmacol. 2011 Nov;26(6):311-5. doi: 10.1097/YIC.0b013e32834ab34c.
Clozapine has superior efficacy for treating patients with schizophrenia. Its discontinuation could have detrimental consequences. We attempted to identify the clinical parameters that could predict clozapine discontinuation in patients diagnosed as having schizophrenia by conducting a retrospective analysis of all of those who started on clozapine treatment during their hospitalization in our institution between 2002 and 2008 (n=100). Demographic and clinical parameters were analyzed and compared between the 58 patients who continued and the 42 who discontinued clozapine treatment during a follow-up period of 8.1 years. Twenty of the latter patients (47.6%) discontinued clozapine because of nonadherence and 11 (26.2%) because of side effects. Thirty-three of them (78.6%) stopped taking clozapine during the first year of treatment. The duration of clozapine use correlated significantly with the time to readmission (P<0.001). The decrease in number of suicide attempts was higher in those who continued clozapine treatment compared with those who discontinued it (P=0.02). Predictors for drug discontinuation were old age at clozapine initiation and comorbid substance abuse. These findings indicate that patients with schizophrenia with those risk factors need special incentives to be compliant during the first year of clozapine treatment to minimize the negative sequelae of clozapine discontinuation.
氯氮平治疗精神分裂症患者的疗效较好。停止使用氯氮平可能会产生不利后果。我们试图通过对 2002 年至 2008 年期间在我院住院期间开始使用氯氮平治疗的所有患者（n=100）进行回顾性分析，确定可预测精神分裂症患者停用氯氮平的临床参数。分析并比较了在 8.1 年的随访期间继续和停用氯氮平治疗的 58 例和 42 例患者的人口统计学和临床参数。后 42 例患者中有 20 例（47.6%）因不遵医嘱和 11 例（26.2%）因副作用而停用氯氮平。其中 33 例（78.6%）在治疗的第一年就停止服用氯氮平。氯氮平的使用时间与再次入院时间显著相关（P<0.001）。与停药相比，继续服用氯氮平治疗的患者自杀企图次数减少（P=0.02）。停药的预测因素是氯氮平起始时年龄较大和合并物质滥用。这些发现表明，具有这些风险因素的精神分裂症患者在氯氮平治疗的第一年需要特别激励以保持依从性，以最大程度地减少氯氮平停药的负面后果。
