Leblanc G, Cormier H, Gagné M A, Vaillancourt S
Department of Psychiatry, Hôpital du Saint-Sacrement, Quebec.
Can J Psychiatry. 1994 May;39(4):223-9. doi: 10.1177/070674379403900406.
This paper presents an open study which evaluated the clinical effects of a partial and progressive reduction in neuroleptic medication in 32 outpatients suffering from schizophrenia who were receiving high doses (equivalent of > or = 18 mg of oral haloperidol per day; EHL). After an observation period of twelve weeks, each subject's dose of neuroleptics was reduced by 50% at the rate of 10% every four weeks. Patients were receiving a mean of 62 mg per day EHL at the beginning of the study and 30 mg per day EHL at the completion of the study. After the reduction, the following was observed: 1. a significant but modest change in psychopathology: a decrease in negative symptoms and in the total score on Brief Psychiatric Rating Scale; and 2. a significant increase in tardive dyskinesia symptoms. Six subjects relapsed but five of them recovered without increasing their reduced medication. Results of this study are discussed in the context of trying to find a minimal maintenance dose in the treatment of schizophrenia. The relative paucity of change despite a large reduction in medication argues for reevaluation of dosage in patients on high or very high doses of neuroleptics. The results suggest that many patients taking high doses could be maintained on significantly lower doses of neuroleptics. With gradual reduction of medication it would seem that many patients who are receiving a high dose of neuroleptic can achieve a lower dose than their current maintenance level.
本文介绍了一项开放性研究，该研究评估了32例接受高剂量（相当于每天口服氟哌啶醇≥18毫克；等效高剂量）治疗的精神分裂症门诊患者逐渐部分减少抗精神病药物剂量的临床效果。经过12周的观察期后，每位受试者的抗精神病药物剂量以每四周10%的速率降低50%。研究开始时患者平均每天接受62毫克等效高剂量的药物治疗，研究结束时为每天30毫克等效高剂量。剂量降低后，观察到以下情况：1. 精神病理学有显著但适度的变化：阴性症状和简明精神病评定量表总分下降；2. 迟发性运动障碍症状显著增加。6名受试者复发，但其中5名在未增加减量药物的情况下康复。本研究结果在试图寻找精神分裂症治疗的最小维持剂量的背景下进行了讨论。尽管药物剂量大幅降低，但变化相对较少，这表明需要重新评估高剂量或非常高剂量抗精神病药物患者的用药剂量。结果表明，许多服用高剂量药物的患者可以维持在显著更低剂量的抗精神病药物治疗。随着药物逐渐减量，似乎许多接受高剂量抗精神病药物治疗的患者可以达到低于其当前维持水平的剂量。
