Lochhead Jeannie D, Nelson Michele A, Schneider Alan L
Department of Psychiatry and Human Behavior, University of California , Irvine, CA, USA.
Ment Illn. 2016 May 18;8(1):6457. doi: 10.4081/mi.2016.6457.
Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.
氯氮平通常被视为治疗精神分裂症的金标准。临床指南建议在2周内逐渐滴定，以降低癫痫发作、低血压、粒细胞缺乏症和心肌炎等不良事件的风险。缓慢滴定往往会延迟达到治疗反应的时间。这就提出了一个问题，即在某些患者中，更快速地滴定氯氮平是否可能是安全的。以下病例说明了使用多种抗精神病药物和快速滴定氯氮平相关的潜在风险。我们报告了一名患有精神分裂症的年轻男子的病例，他在快速滴定氯氮平和使用多种抗精神病药物治疗期间发生了危及生命的抗精神病药恶性综合征（NMS）。我们在文献中未能找到另一例与快速滴定氯氮平相关的NMS病例。该病例旨在敦促临床医生仔细评估快速滴定氯氮平的风险和益处，并鼓励研究人员进一步评估快速滴定氯氮平的安全性。快速滴定氯氮平对于降低与长期住院相关的医疗保健成本以及减轻与未控制的精神病症状相关的情感痛苦具有意义。氯氮平被认为是现有的最有效的抗精神病药物，因此应努力制定策略，以实现氯氮平的最安全、最有效的使用，从而鼓励将其用于治疗难治性精神分裂症。
