Department of Neurology and the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine of Yeshiva University, NY, USA.
J Clin Psychiatry. 2012 Feb;73(2):e07. doi: 10.4088/JCP.11076tx2c.
Atypical antipsychotics are recommended as first-line treatment for schizophrenia, but patients may have little or no response to an initial antipsychotic trial. Strategies for managing treatment nonresponse include increasing the dose, addressing nonadherence, augmenting the original medication, and switching the patient to another medication. Clozapine is recommended for patients with schizophrenia who have not responded to 2 other antipsychotic trials of adequate duration, but many physicians are hesitant to prescribe clozapine due to the complexity of the treatment regimen and the possibility of severe adverse effects. However, for patients with resistant schizophrenic symptoms, the benefits of clozapine may outweigh the risks. Data show that patients have more favorable opinions of clozapine treatment than many physicians expect. If clozapine treatment is initiated, physicians should mitigate risk by carefully monitoring and addressing side effects.
非典型抗精神病药物被推荐作为精神分裂症的一线治疗药物，但患者可能对初始抗精神病药物试验没有反应或反应很小。处理治疗无反应的策略包括增加剂量、解决不依从性、增强原药物和将患者切换到另一种药物。氯氮平被推荐用于对 2 种其他足够疗程的抗精神病药物试验没有反应的精神分裂症患者，但由于治疗方案的复杂性和严重不良反应的可能性，许多医生不愿意开氯氮平。然而，对于有耐药性精神分裂症症状的患者，氯氮平的益处可能超过风险。数据表明，患者对氯氮平治疗的评价比许多医生预期的要好。如果开始氯氮平治疗，医生应通过仔细监测和处理副作用来降低风险。
