Kalenderoğlu Aysun, Çelik Mustafa
Turk Psikiyatri Derg. 2016 Spring;27(1):57-62.
Clozapine is the only antipsychotic which has definitely shown to be effective in refractory schizophrenia. Clozapine treatment is usually preferred in schizophrenia patients with a partial response to treatment and augmentation strategies are tried when clozapine also fails to provide full treatment response. In treatment resistant schizophrenia patients addition of a second antipsychotic is a frequently preferred augmentation method. With previous augmentation strategies consistent positive results could not be obtained. Paliperidone is a risperidone metabolite and it has proven effectiveness in schizophrenia treatment. Although most effects of paliperidone on central nervous system are similar with risperidone, there are some differences. In this case series treatments of 5 schizophrenia patients who still had symptoms despite clozapine treatment were augmented with paliperidone during 6 months of follow up. This augmentation was tolerated well by the patients, and caused improvements in both positive and negative symptoms. Particularly, improvement in negative symptoms after addition of paliperidone was remarkable in our patients. Evaluation of paliperidone's effects on negative symptoms in schizophrenia patients with partial response to clozapine treatment using randomized, placebo controlled studies may provide an important treatment choice.
氯氮平是唯一一种已明确显示对难治性精神分裂症有效的抗精神病药物。对于对治疗有部分反应的精神分裂症患者，通常首选氯氮平治疗，当氯氮平也未能提供完全的治疗反应时，则尝试采用增效策略。在治疗抵抗性精神分裂症患者中，添加第二种抗精神病药物是一种常用的增效方法。以往的增效策略未能获得一致的阳性结果。帕利哌酮是利培酮的代谢产物，已证实其在精神分裂症治疗中有效。尽管帕利哌酮对中枢神经系统的大多数作用与利培酮相似，但仍存在一些差异。在本病例系列中，对5例尽管接受氯氮平治疗仍有症状的精神分裂症患者在6个月的随访期间用帕利哌酮进行增效治疗。患者对这种增效治疗耐受性良好，且阳性和阴性症状均有改善。特别是，在我们的患者中，添加帕利哌酮后阴性症状的改善非常显著。使用随机、安慰剂对照研究评估帕利哌酮对氯氮平治疗有部分反应的精神分裂症患者阴性症状的影响，可能会提供一种重要的治疗选择。
