Wolkowitz O M
Langley Porter Psychiatric Institute, University of California, San Francisco Medical Center 94143.
Ann Clin Psychiatry. 1993 Jun;5(2):79-90. doi: 10.3109/10401239309148967.
Approximately 10 to 30% of patients with schizophrenia show poor response to neuroleptics alone. An initial evaluative and treatment approach to these patients is outlined, and the literature on adjunctive treatments, which seek to augment neuroleptic effects, is reviewed. The greatest evidence for efficacy has been shown for lithium, benzodiazepines, carbamazepine, reserpine, and electroconvulsive therapy, although individual patients may also respond to propranolol, clonidine, valproic acid, and L-dopa. Antidepressants may also be useful for treating comorbid depression in nonacutely psychotic patients. One general theme is that no one adjunctive treatment benefits all patients; indeed, only a minority of patients responds to any given agent. Therefore, the choice of specific treatments is best guided by the clinical characteristics of the individual patient. These observations raise the possibility that subgroups of schizophrenia exist; delineation of differences in clinical response to biochemically distinct agents may help elucidate such underlying differences between patient groups.
约10%至30%的精神分裂症患者对单独使用抗精神病药物反应不佳。本文概述了针对这些患者的初步评估和治疗方法，并综述了旨在增强抗精神病药物疗效的辅助治疗相关文献。锂盐、苯二氮䓬类药物、卡马西平、利血平和电休克治疗已显示出最大的疗效证据，尽管个别患者也可能对普萘洛尔、可乐定、丙戊酸和左旋多巴有反应。抗抑郁药也可能有助于治疗非急性精神病患者的共病性抑郁。一个普遍的主题是，没有一种辅助治疗对所有患者都有益；事实上，只有少数患者对任何一种特定药物有反应。因此，具体治疗方法的选择最好以个体患者的临床特征为指导。这些观察结果增加了精神分裂症存在亚组的可能性；描绘对生化性质不同的药物的临床反应差异可能有助于阐明患者群体之间的潜在差异。
