Meyer Jonathan M
California Department of State Hospitals,Patton,California,USA;Mental Health Intensive Case Management,VA San Diego Healthcare System,San Diego,California,USA;University of California,San Diego,San Diego,California,USA;Loma Linda University,California,USA.
CNS Spectr. 2014 Oct;19(5):432-8. doi: 10.1017/S1092852914000236. Epub 2014 May 27.
Forensic psychiatric settings contain a high prevalence of treatment-resistant violent schizophrenia patients. Clozapine therapy has the most robust data for the management of violence in patients with schizophrenia, but for those who cannot tolerate or refuse clozapine, high-dose antipsychotic treatment to high achieve high plasma levels remains a viable option despite limited evidence for efficacy in controlled trials. This article enumerates rational guidelines for employing high plasma level strategies, emphasizing the appropriate interpretation of, and reaction to high plasma antipsychotic levels in these treatment resistant patients, and the need to push treatment to the limits of tolerability or clinical response.
法医精神病学环境中存在大量难治性暴力型精神分裂症患者。氯氮平治疗在管理精神分裂症患者的暴力行为方面拥有最为充分的数据，但对于那些无法耐受或拒绝氯氮平的患者，采用高剂量抗精神病药物治疗以达到高血浆水平仍是一个可行的选择，尽管在对照试验中其疗效证据有限。本文列举了采用高血浆水平策略的合理指导原则，强调对这些难治性患者高血浆抗精神病药物水平的恰当解读及应对措施，以及将治疗推向耐受性或临床反应极限的必要性。
