Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, Pok Fu Lam, Hong Kong.
Department of Psychiatry, Monash University, Melbourne, Australia.
Psychopharmacology (Berl). 2022 Nov;239(11):3393-3420. doi: 10.1007/s00213-022-06241-2. Epub 2022 Sep 30.
Though clozapine is recommended for treatment of tardive dyskinesia (TD) relating to the use of antipsychotic medications, studies comprehensively investigating the treatment effect of clozapine on TD are still limited.
This review examines the effectiveness of clozapine as an intervention for tardive dyskinesia and dystonia in patients with all psychiatric conditions. Effectiveness of clozapine, duration to exert the effect and dosage used were also analysed.
A search in the PubMed, PsycINFO and clinicaltrials databases was performed, using the search terms "Clozapine" AND "dyskinesia" OR "dystonia". Full-text articles that reported the use of clozapine to treat abnormal involuntary movements and were written in English were included.
A total of 48 studies were identified, of which 13 were clinical trials and 35 were case reports. Significant improvement was seen in 86.7% of patients with schizophrenia spectrum disorders (average dose of clozapine = 355 mg/day) and 93% of patients with other psychiatric disorders (average dose of clozapine = 152.5 mg/day). Patients with other psychiatric diagnoses had faster improvement than the patients with schizophrenia spectrum disorders. Variation in improvements and dosage were also seen in the clinical trials.
Results suggested an overall effectiveness of clozapine in the treatment of TD for patients with a range of psychiatric conditions. Different response time and clozapine dosage were seen in patients with different psychiatric conditions, suggesting different treatment protocols are required for different conditions. Most of the studies identified are of inadequate qualities, highlighting the need for high quality studies to provide clearer evidence.
氯氮平被推荐用于治疗与抗精神病药物使用相关的迟发性运动障碍（TD），但全面评估氯氮平治疗 TD 效果的研究仍很有限。
本综述考察了氯氮平治疗各种精神疾病患者 TD 和肌张力障碍的疗效。还分析了氯氮平的疗效、起效时间和使用剂量。
在 PubMed、PsycINFO 和临床试验数据库中使用“Clozapine”和“dyskinesia”或“dystonia”检索词进行检索，纳入报告使用氯氮平治疗异常不自主运动且为英文全文的研究。
共确定了 48 项研究，其中 13 项为临床试验，35 项为病例报告。精神分裂症谱系障碍患者中 86.7%（氯氮平平均剂量为 355mg/天）和其他精神障碍患者中 93%（氯氮平平均剂量为 152.5mg/天）的患者症状显著改善。其他精神障碍患者的改善速度快于精神分裂症谱系障碍患者。临床试验中也观察到了改善和剂量的差异。
结果表明，氯氮平治疗多种精神疾病患者 TD 的总体疗效较好。不同精神疾病患者的起效时间和氯氮平剂量不同，提示不同疾病需要不同的治疗方案。大多数确定的研究质量较差，需要高质量的研究来提供更明确的证据。
