Aksoy Poyraz Cana, Turan Şenol, Demirel Ömer Faruk, Usta Sağlam Nazife Gamze, Yıldız Nazım, Duran Alaattin
Department of Psychiatry, Cerrahpaşa Medical School, Halaskargazi cad. No: 81 Çiçek apt. daire: 8, Osmanbey Istanbul, Turkey.
Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
Ther Adv Psychopharmacol. 2015 Aug;5(4):237-42. doi: 10.1177/2045125315584871.
Treatment of severe and refractory manic episodes in hospital settings can occasionally be very difficult. In particular, severely excited patients showing aggressive, hostile, impulsive behaviours frequently require physical restraint and seclusion, high doses of antipsychotics and benzodiazepines, and sometimes, electroconvulsive therapy. Hospital stay is generally prolonged and such patients cause great emotional distress for other patients in the ward and clinical staff involved in their care. Here we report on three patients with a diagnosis of bipolar disorder and one patient with a diagnosis of schizoaffective disorder bipolar subtype, all of whom were hospitalized for severe manic episodes with psychotic features. These patients were extremely difficult to manage in the ward as no response could be obtained in the first week of treatment despite high doses of antipsychotics and benzodiazepine administration. The introduction and rapid titration of clozapine proved remarkably effective and was well tolerated in the acute management of these patients. We observed that clozapine had a superior and fast mood stabilization effect with rapid titration and could be extremely helpful in the management of such patients.
在医院环境中，治疗严重且难治性躁狂发作有时会非常困难。特别是，表现出攻击性、敌意、冲动行为的严重兴奋患者常常需要身体约束和隔离、高剂量的抗精神病药物和苯二氮䓬类药物，有时还需要进行电休克治疗。住院时间通常会延长，这类患者会给病房中的其他患者以及参与其护理的临床工作人员带来极大的情绪困扰。在此，我们报告3例诊断为双相情感障碍的患者和1例诊断为精神分裂症性障碍双相亚型的患者，他们均因伴有精神病性特征的严重躁狂发作而住院。这些患者在病房中极难管理，因为尽管给予了高剂量的抗精神病药物和苯二氮䓬类药物，但在治疗的第一周仍未取得任何效果。事实证明，氯氮平的引入和快速滴定在这些患者的急性管理中非常有效且耐受性良好。我们观察到，氯氮平通过快速滴定具有卓越且快速的情绪稳定作用，对管理这类患者可能会有极大帮助。
