Poyraz Cana Aksoy, Özdemir Armağan, Sağlam Nazife Gamze Usta, Turan Şenol, Poyraz Burç Çağrı, Tomruk Nesrin, Duran Alaattin
Department of Psychiatry, Cerrahpaşa Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
Psychiatr Q. 2016 Jun;87(2):315-22. doi: 10.1007/s11126-015-9394-y.
The aim of this study is to evaluate the safety and effectiveness of rapid clozapine titration in patients with schizophrenia in hospital settings. We conducted a retrospective two-center cohort study to compare the safety and effectiveness of clozapine with different titration rates in treatment-refractory patients with schizophrenia. In the first center, clozapine was started at 25-50 mg followed by 50-100 mg as needed every 6 h on day 1, followed by increases of 50-100 mg/day. In the second center, titration was slower; clozapine initiated with 12.5-50 mg on day 1 followed by increases of 25-50 mg/day. The number of days between starting of clozapine until discharge was shorter in the rapid titration group (22.4 ± 8.72 vs 27.0 ± 10.5, p = 0.1). Number of days of total hospital stay were significantly shorter in the rapid titration group (29.6 ± 10.6 vs 41.2 ± 14.8, p = 0.002). Hypotension was more common in the rapid titration group and one patient had suspected myocarditis. Rapid clozapine titration appeared safe and effective. The length of stay following initiation of clozapine was shorter in the rapid-titration group, although this was not statistically significant. However starting clozapine earlier together with rapid titration has significantly shortened the length of hospital stay in patients with treatment refractory schizophrenia.
本研究的目的是评估在医院环境中对精神分裂症患者进行氯氮平快速滴定的安全性和有效性。我们进行了一项回顾性双中心队列研究，以比较不同滴定速率的氯氮平在难治性精神分裂症患者中的安全性和有效性。在第一个中心，氯氮平起始剂量为25 - 50mg，第1天根据需要每6小时增加50 - 100mg，随后每天增加50 - 100mg。在第二个中心，滴定速度较慢；第1天氯氮平起始剂量为12.5 - 50mg，随后每天增加25 - 50mg。快速滴定组从开始使用氯氮平到出院的天数较短（22.4 ± 8.72天 vs 27.0 ± 10.5天，p = 0.1）。快速滴定组的总住院天数显著缩短（29.6 ± 10.6天 vs 41.2 ± 14.8天，p = 0.002）。低血压在快速滴定组中更常见，且有1例患者疑似心肌炎。氯氮平快速滴定似乎是安全有效的。快速滴定组在开始使用氯氮平后的住院时间较短，尽管这在统计学上不显著。然而，早期开始使用氯氮平并进行快速滴定显著缩短了难治性精神分裂症患者的住院时间。
