Harrison Zoe, Haeney Owen, Brereton William
University of Adelaide, Faculty of Health and Medical Sciences, 4 North Terrace, Adelaide South Australia 5000, Australia.
Forensic Mental Health Service/Northern Adelaide Local Health Network, James Nash House, 140 Hilltop Drive, Oakden, Adelaide South Australia 5086, Australia.
Case Rep Psychiatry. 2021 Jun 19;2021:5525398. doi: 10.1155/2021/5525398. eCollection 2021.
Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.
精神分裂症的治疗抵抗在临床实践中经常遇到，通常推荐氯氮平作为合适的治疗方法。然而，当氯氮平被证明无效或因副作用无法耐受时，治疗选择就很有限。在法医精神卫生服务机构的患者中，残留症状往往成为出院的障碍，并且可能对康复前景以及对自身和他人的风险产生持久影响。本文综述了相关文献，并介绍了三例采用新方法的病例，即使用通常被认为低于治疗剂量的氯氮平，并与主要抗精神病药物治疗联合使用。在所有三名患者中，这种方法提高了临床疗效和耐受性，使患者得以改善并从法医医院出院。
