Porras-Segovia Alejandro, Krivoy Amir, Horowitz Mark, Thomas George, Bolstridge Mark, Ion Dragos, Shergill Sukhwinder S
, MD, University of Granada, Granada, Spain.
, MD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Psychosis Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust London, London, UK.
BJPsych Open. 2017 May 11;3(3):138-140. doi: 10.1192/bjpo.bp.117.004481. eCollection 2017 May.
Clozapine has proved to be an effective antipsychotic for the treatment of refractory schizophrenia - characterised by the persistence of symptoms despite optimal treatment trials with at least two different antipsychotics at adequate dose and duration - but its use is hampered by adverse effects. The development of clozapine-induced diabetes is commonly considered to arise as part of a metabolic syndrome, associated with weight gain, and thus evolves slowly. We present the case of an individual with refractory schizophrenia and metformin-controlled diabetes who developed rapid-onset insulin-dependent hyperglycaemia immediately after starting clozapine. Given the refractory nature of his illness, the decision was made to continue clozapine and manage the diabetes. This case supports the existence of a more direct mechanism by which clozapine alters glycaemic control, aside from the more routine slow development of a metabolic syndrome.
S.S.S. is supported by a European Research Council Consolidator Award (Grant Number 311686) and the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report.
© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
氯氮平已被证明是治疗难治性精神分裂症的一种有效抗精神病药物——难治性精神分裂症的特征是尽管使用至少两种不同的抗精神病药物进行了足够剂量和疗程的最佳治疗试验，但症状仍持续存在——但其使用受到不良反应的阻碍。氯氮平诱发的糖尿病通常被认为是代谢综合征的一部分，与体重增加有关，因此发展缓慢。我们报告了一例难治性精神分裂症患者的病例，该患者患有二甲双胍控制的糖尿病，在开始使用氯氮平后立即出现了快速发作的胰岛素依赖型高血糖症。鉴于其病情的难治性，决定继续使用氯氮平并治疗糖尿病。该病例支持了除了更常见的代谢综合征缓慢发展之外，氯氮平改变血糖控制存在更直接机制的观点。
S.S.S. 得到了欧洲研究理事会巩固者奖（资助编号311686）以及英国国家卫生研究院（NIHR）心理健康生物医学研究中心（位于伦敦南部和莫兹利国民保健服务基金会信托基金以及伦敦国王学院）的支持。资助者在研究设计、数据收集、数据分析、数据解释或报告撰写方面没有任何作用。
© 皇家精神病医学院2017年。这是一篇开放获取文章，根据知识共享非商业性、无衍生作品（CC BY-NC-ND）许可协议分发。
