Department of Psychiatry, University of Helsinki, Finland.
Int J Psychiatry Clin Pract. 1999;3(3):159-69. doi: 10.3109/13651509909022729.
Schizophrenia resistance to conventional antipsychotics is a common phenomenon. In 5-25% of cases, satisfactory treatment response is not achieved, and intolerance to conventional antipsychotics occurs in 5-20% of patients. Numerous reasons for refractoriness have been proposed. However, up to now only a few pharmacological agents have been found useful in the treatment of schizophrenia resistant to conventional antipsychotics. This paper critically reviews quality-assessed trials on the pharmacological treatment of refractory schizophrenia. Randomized blinded trials of conventional antipsychotics at high doses, atypical antipsychotics, lithium, propranolol, and agents not traditionally used in the treatment of schizophrenia are reviewed. On the basis of the methodologically sound studies included, we conclude that only clozapine has proved to be clinically effective in the treatment of refractory schizophrenia. In the short term, the odds ratio for clinical improvement on clozapine treatment when compared to conventional treatment is calculated to be 2.4 (95% confidence interval [CI] 1.7-3.5) and the number of patients needed to treat (NNT) is 7 (95% CI 5-13). In single inconclusive trials, olanzapine and risperidone have been found as effective as clozapine. In order to establish the usefulness of other pharmacological treatments, more randomized clinical trials are needed.
抗精神分裂症药物治疗抵抗是一种常见现象。在 5-25%的病例中，治疗反应不理想，5-20%的患者对传统抗精神分裂症药物不耐受。已经提出了许多导致抵抗的原因。然而，到目前为止，只有少数几种药理学药物被发现对治疗传统抗精神分裂症药物抵抗有效。本文批判性地回顾了经质量评估的治疗难治性精神分裂症的药理学试验。综述了高剂量传统抗精神病药物、非典型抗精神病药物、锂、普萘洛尔和传统上不用于治疗精神分裂症的药物的随机双盲试验。根据纳入的方法学合理的研究，我们得出结论，只有氯氮平已被证明对治疗难治性精神分裂症具有临床疗效。与传统治疗相比，氯氮平治疗的临床改善的优势比（OR）估计为 2.4（95%置信区间[CI] 1.7-3.5），需要治疗的患者数（NNT）为 7（95%CI 5-13）。在单一非结论性试验中，奥氮平和利培酮被发现与氯氮平一样有效。为了确定其他药理学治疗的有效性，需要进行更多的随机临床试验。
