Higgins P B
Clinical Studies Unit, Western State Hospital, Staunton, VA 24401, USA.
Health Soc Work. 1995 May;20(2):124-32. doi: 10.1093/hsw/20.2.124.
Clozapine, an atypical antipsychotic medication, is the most significant pharmacological advancement in the treatment of chronic schizophrenia in years. Effective in treating the nearly 30 percent of people with schizophrenia who do not respond to conventional pharmacological and psychosocial therapies, clozapine offers new hope to many. However, high cost, a potentially lethal side effect, and a weekly mandatory monitoring system have hampered access to clozapine treatment. This article reviews a brief history of clozapine use in the United States and also the unique features of the medication. Economic, ethical, and personnel resource issues of clozapine use are summarized. The author describes her clinical experiences with the psychosocial issues faced by those who respond to clozapine treatment, case highlights, and social work interventions. Social work advocacy for increased access to clozapine, the potential contributions of social workers in the selection of patients for treatment, and the logistical management issues confronting social workers in inpatient and outpatient mental health settings are addressed.
氯氮平是一种非典型抗精神病药物，是多年来慢性精神分裂症治疗领域最重要的药理学进展。氯氮平对近30% 对传统药物和心理社会疗法无反应的精神分裂症患者有效，给许多人带来了新希望。然而，高昂的成本、潜在的致命副作用以及每周强制监测系统阻碍了氯氮平治疗的可及性。本文回顾了氯氮平在美国使用的简史以及该药物的独特特性。总结了使用氯氮平的经济、伦理和人力资源问题。作者描述了她在临床中对氯氮平治疗有反应的患者所面临的心理社会问题的经验、案例要点以及社会工作干预措施。探讨了社会工作为增加氯氮平可及性所做的倡导、社会工作者在患者治疗选择中的潜在贡献，以及住院和门诊心理健康环境中社会工作者面临的后勤管理问题。
