Chengappa K N, Shelton M D, Baker R W, Schooler N R, Baird J, Delaney J
Special Studies Center, Mayview State Hospital, Pittsburgh, PA.
J Clin Psychiatry. 1994 Apr;55(4):142-5.
Akathisia is a common side effect of traditional neuroleptic drugs and is associated with medication refusal and impulsive behavior. While our previous experience indicates that clozapine is effective in treating persistent akathisia, two controlled studies indicate vastly different prevalence rates of akathisia (7% vs. 40%) in patients receiving clozapine.
We used the Barnes Rating Scale for Drug-Induced Akathisia to estimate the prevalence of akathisia in patients receiving stable doses of clozapine alone (N = 29) in a state hospital. Measurements were also made of manifest psychopathology (Brief Psychiatric Rating Scale) and tardive dyskinesia (Abnormal Involuntary Movement Scale).
Two patients (6.8%) receiving clozapine were rated as having akathisia. Only 4 (28.6%) of the 14 subjects with a history of moderate-to-severe tardive dyskinesia on traditional neuroleptic drugs continued to show current evidence of tardive dyskinesia, and in 10 patients (71.4%) there was no evidence of the syndrome (p < .002). In the 4 subjects with tardive dyskinesia there was amelioration to a milder form of the syndrome. There were no new cases of tardive dyskinesia among clozapine-treated subjects.
These data support the low prevalence of akathisia in patients receiving stable doses of clozapine monotherapy. There is further support that clozapine has an ameliorating effect on tardive dyskinesia associated with traditional neuroleptic drugs. These and other data indicate the need for a controlled trial of clozapine in patients experiencing persistent and disabling akathisia on traditional neuroleptic drugs.
静坐不能是传统抗精神病药物常见的副作用，与拒服药物及冲动行为相关。虽然我们之前的经验表明氯氮平对治疗持续性静坐不能有效，但两项对照研究显示接受氯氮平治疗的患者中静坐不能的患病率差异极大（7%对40%）。
我们使用巴恩斯药物所致静坐不能评定量表，对一家州立医院中单独接受稳定剂量氯氮平治疗的患者（N = 29）的静坐不能患病率进行评估。还对明显的精神病理学症状（简明精神病评定量表）和迟发性运动障碍（异常不自主运动量表）进行了测量。
接受氯氮平治疗的两名患者（6.8%）被评定为有静坐不能。在14名既往使用传统抗精神病药物时有中度至重度迟发性运动障碍病史的受试者中，只有4名（28.6%）目前仍有迟发性运动障碍的证据，10名患者（71.4%）没有该综合征的证据（p <.002）。在4名有迟发性运动障碍的受试者中，该综合征有所改善，变为较轻的形式。接受氯氮平治疗的受试者中没有出现新的迟发性运动障碍病例。
这些数据支持单独接受稳定剂量氯氮平单一疗法的患者中静坐不能患病率较低。进一步支持了氯氮平对与传统抗精神病药物相关的迟发性运动障碍有改善作用。这些及其他数据表明，有必要对在传统抗精神病药物治疗下出现持续性且致残性静坐不能的患者进行氯氮平对照试验。
