Yalcin Ozhan, Kaymak Gizem, Erdogan Ayten, Tanidir Canan, Karacetin Gul, Kilicoglu Ali Guven, Mutlu Caner, Adaletli Hilal, Gunes Hatice, Bahali Kayhan, Ayik Basak, Uneri Ozden Sukran
1 Child and Adolescent Psychiatry, Bakirkoy Psychiatry, Neurology, Neurosurgery Trainee, and Research Hospital , Child and Adolescent Psychiatry Clinic, Istanbul, Turkey .
2 Child and Adolescent Psychiatry, Duzce University Medical Faculty , Child and Adolescent Psychiatry Clinic, Duzce, Turkey .
J Child Adolesc Psychopharmacol. 2016 Nov;26(9):815-821. doi: 10.1089/cap.2015.0020. Epub 2016 Jan 15.
The aim of this retrospective study is to examine the clinical outcomes and safety of clozapine in children and adolescents with schizophrenia or other psychotic disorders/autism spectrum disorder (ASD) or affective disorders.
The inpatient and outpatient files of all children and adolescents treated with clozapine over a period of 34 months (from October 2011 to July 2014) were reviewed. Demographic and clinical data were examined to describe clinical and metabolic findings, dosing, and tolerability of clozapine treatment in youth with schizophrenia, other psychotic disorders, ASD, or bipolar disorder.
The 37 pediatric patients included 26 patients with schizophrenia or other psychotic disorders, 7 patients with ASD complicated by schizophrenia or other psychotic disorders or affective disorders, and 4 patients with ASD only. In all groups (n = 37) there was a significant reduction (p < 0.001) in Brief Psychiatric Rating Scale (BPRS) points after clozapine treatment during the inpatient period (38.78 ± 27.75 days). In patients with schizophrenia or other psychotic disorders co-occurring with ASD or not (n = 31), there was a significant improvement in psychotic symptoms according to Positive and Negative Syndrome Scale (PANSS) total scores and subscores (p < 0.001). Of the 26 patients with schizophrenia or other psychotic disorders, 8 (30.8%) showed a positive response (>30% symptom reduction on BPRS). In patients with ASD complicated by schizophrenia or other psychotic disorders or bipolar disorders (n = 7), there was a significant reduction (p = 0.017) in BPRS scores after clozapine treatment. The discontinuation rate for clozapine was 10.8%, and the most frequently observed side effect was hypersalivation (54.1%). Neutropenia associated with clozapine was observed in only one patient (2.7%).
Clozapine seems to be effective and safe in children and adolescents with schizophrenia or other psychotic disorders co-occuring with ASD or not. There is a need for further studies for determining the efficacy of clozapine in children and adolescents with bipolar affective disorder or ASD.
本回顾性研究旨在探讨氯氮平治疗儿童及青少年精神分裂症、其他精神障碍/自闭症谱系障碍（ASD）或情感障碍的临床疗效及安全性。
回顾了34个月（2011年10月至2014年7月）期间所有接受氯氮平治疗的儿童及青少年的住院和门诊病历。检查人口统计学和临床数据，以描述氯氮平治疗青少年精神分裂症、其他精神障碍、ASD或双相情感障碍的临床及代谢结果、用药剂量和耐受性。
37例儿科患者中，26例患有精神分裂症或其他精神障碍，7例ASD合并精神分裂症或其他精神障碍或情感障碍，4例仅患有ASD。在所有组（n = 37）中，住院期间（38.78±27.75天）氯氮平治疗后简明精神病评定量表（BPRS）评分显著降低（p < 0.001）。在患有或未患有ASD的精神分裂症或其他精神障碍患者（n = 31）中，根据阳性和阴性症状量表（PANSS）总分及各分项评分，精神病症状有显著改善（p < 0.001）。26例精神分裂症或其他精神障碍患者中，8例（30.8%）显示阳性反应（BPRS评分症状减轻>30%）。在ASD合并精神分裂症或其他精神障碍或双相情感障碍患者（n = 7）中，氯氮平治疗后BPRS评分显著降低（p = 0.017）。氯氮平的停药率为10.8%，最常观察到的副作用是流涎过多（54.1%）。仅1例患者（2.7%）观察到与氯氮平相关的中性粒细胞减少。
氯氮平似乎对患有或未患有ASD的精神分裂症或其他精神障碍的儿童及青少年有效且安全。需要进一步研究以确定氯氮平对双相情感障碍或ASD儿童及青少年的疗效。
Zotero 插件