Varghese M Tom, Jyothi K S, Shaji K S, Rita Venugopal Lekshmi
Department of Psychiatry, Government Medical College Thrissur, Thrissur, Kerala, India.
Department of Psychiatry, General Hospital Kozhikode, Kozhikode, Kerala, India.
Gen Psychiatr. 2020 Apr 28;33(2):e100172. doi: 10.1136/gpsych-2019-100172. eCollection 2020.
Although clozapine is the most effective drug for treatment-resistant schizophrenia, its use remains restricted in clinical practice in India. The delay in initiating treatment with clozapine and its impact on disease outcome needs evaluation.
To identify the implications of delaying clozapine initiation in clinical outcomes among people with treatment-resistant schizophrenia.
Subjects with treatment-resistant schizophrenia, stabilised on clozapine monotherapy, were recruited from the outpatient clinic of a general hospital psychiatry unit offering tertiary care services in Thrissur district, Kerala, India. A retrospective cohort design was employed, and information on duration of illness, total duration of treatment and duration of treatment with clozapine was collected. Present symptom status was measured using the Positive and Negative Syndrome Scale. Factors associated with higher symptom scores were analysed using an independent sample test, Spearman correlation and multiple linear regression.
Forty subjects stabilised on long-term clozapine therapy formed the study sample. The mean dose of clozapine used in the study population was 200 mg. The mean duration of antipsychotic treatment before starting clozapine was 89.3 months (7.4 years). The duration of treatment before starting clozapine was found to have a significant positive association with the total Positive and Negative Syndrome Scale score (correlation coefficient 0.40; p=0.01) and negative symptom score (correlation coefficient 0.33; p=0.04). The multiple regression analysis adjusting for covariates showed that the duration of treatment before starting clozapine was an independent factor associated with a higher negative symptom score in the Positive and Negative Syndrome Scale (slope β=0.05; p=0.02; R=0.27).
Poor treatment outcomes in treatment-resistant schizophrenia could be secondary to a delay in initiating clozapine therapy.
尽管氯氮平是治疗难治性精神分裂症最有效的药物，但在印度的临床实践中其使用仍受到限制。启动氯氮平治疗的延迟及其对疾病结局的影响需要评估。
确定难治性精神分裂症患者中延迟启动氯氮平治疗对临床结局的影响。
从印度喀拉拉邦特里苏尔地区一家提供三级护理服务的综合医院精神科门诊招募接受氯氮平单一疗法稳定治疗的难治性精神分裂症患者。采用回顾性队列设计，收集疾病持续时间、总治疗持续时间和氯氮平治疗持续时间的信息。使用阳性和阴性症状量表测量当前症状状态。使用独立样本检验、Spearman相关性分析和多元线性回归分析与较高症状评分相关的因素。
40名接受长期氯氮平治疗的稳定患者构成研究样本。研究人群中使用的氯氮平平均剂量为200毫克。开始使用氯氮平前抗精神病药物治疗的平均持续时间为89.3个月（7.4年）。发现开始使用氯氮平前的治疗持续时间与阳性和阴性症状量表总分（相关系数0.40；p=0.01）和阴性症状评分（相关系数0.33；p=0.04）呈显著正相关。调整协变量后的多元回归分析表明，开始使用氯氮平前的治疗持续时间是与阳性和阴性症状量表中较高阴性症状评分相关的独立因素（斜率β=0.05；p=0.02；R=0.27）。
难治性精神分裂症治疗效果不佳可能是由于启动氯氮平治疗延迟所致。
