Berman I, Sapers B L, Chang H H, Losonczy M F, Schmildler J, Green A I
Commonwealth Research Center, Massachusetts Mental Health Center, Harvard Medical School, Department of Psychiatry, Boston, USA.
J Clin Psychopharmacol. 1995 Jun;15(3):206-10. doi: 10.1097/00004714-199506000-00009.
Recent studies show that obsessive-compulsive symptoms may occur in many patients with schizophrenia and may predict a poor prognosis. Pilot studies have shown that some schizophrenic patients may improve if a serotonin reuptake blocker is added to their neuroleptic. We have performed a pilot, double-blind, crossover study of clomipramine (CMI) or placebo, added to maintenance psychotropic medication. Six schizophrenic patients with obsessive-compulsive symptoms were studied in a double-blind CMI versus placebo crossover protocol. The patients met DSM-III-R criteria for chronic schizophrenia, experienced obsessive-compulsive symptoms, and had been previously stabilized on their psychiatric medication. The patients were rated at baseline and longitudinally through the study with the Positive and Negative Symptom Scale for Schizophrenia (PANSS) and the Yale Brown Obsessive-Compulsive Scale (YBOCS). An analysis of covariance was used to compare the drug versus placebo effect at the final visit with the baseline rating as a covariate. Ratings on both the YBOCS and the PANSS showed that patients improved significantly more on CMI than on placebo. No patients experienced an exacerbation of psychotic symptoms. Preliminary findings from this double-blind, crossover, pilot study of CMI and placebo, designed to assess the effect of CMI in the treatment of schizophrenic patients with obsessive symptoms, suggest that CMI is superior to placebo in the treatment of obsessions and compulsions and improves overall schizophrenic symptoms. Further studies with larger samples and longer follow-up period are necessary to confirm these preliminary findings.
近期研究表明，强迫症症状可能出现在许多精神分裂症患者中，并且可能预示预后不良。初步研究显示，一些精神分裂症患者若在其抗精神病药物中添加5-羟色胺再摄取阻滞剂，症状可能会有所改善。我们进行了一项关于氯米帕明（CMI）或安慰剂添加到维持性精神药物治疗中的初步双盲交叉研究。六名有强迫症症状的精神分裂症患者按照双盲CMI与安慰剂交叉方案进行研究。这些患者符合DSM-III-R慢性精神分裂症标准，有强迫症症状，且之前已通过精神科药物治疗病情稳定。患者在基线期接受评估，并在整个研究过程中通过精神分裂症阳性和阴性症状量表（PANSS）以及耶鲁布朗强迫症量表（YBOCS）进行纵向评估。使用协方差分析将末次访视时药物与安慰剂效应进行比较，以基线评分作为协变量。YBOCS和PANSS的评分均显示，患者使用CMI时的改善程度显著高于使用安慰剂时。没有患者出现精神病性症状加重。这项旨在评估CMI对有强迫症状的精神分裂症患者治疗效果的双盲交叉初步研究的初步结果表明，CMI在治疗强迫观念和强迫行为方面优于安慰剂，并能改善整体精神分裂症症状。需要进行更大样本量和更长随访期的进一步研究来证实这些初步结果。
