Peacock L, Solgaard T, Lublin H, Gerlach J
St. Hans Hospital, Roskilde, Denmark.
Psychopharmacology (Berl). 1996 Mar;124(1-2):188-96. doi: 10.1007/BF02245620.
Schizophrenic patients in long-term neuroleptic monotherapy with clozapine (n = 100) and perphenazine, flupenthixol or zuclopentixol (controls, n = 100) were evaluated for extrapyramidal side effects (EPS) (blind) as well as other side effects and mental condition (non-blind). In both groups the patients had received neuroleptic treatment for a total of 14 years (median) and the present antipsychotic (clozapine or control drug) for 5 years. Thus the clozapine-treated patients had previously received traditional neuroleptics for 9 years (median). The study was both retrospective (0.3-19 years for clozapine, 0.3-24 years for control drug, by means of chart information) and prospective (1 year, with video-controlled evaluation of EPS). There was a significantly lower prevalence of tardive dyskinesia (TD) in clozapine treated patients than control patients, although prior to this treatment there were more TD patients in the clozapine group (P < 0.05). This lower level of TD in the clozapine group was related to a lower induction of new cases (P < 0.001) and a tendency towards greater disappearance of TD in the clozapine than in the control group (P = 0.07). Clozapine treated patients without TD had started clozapine and ceased traditional neuroleptics at an earlier age than those with TD. Parkinsonian signs were seen in 33% of the clozapine patients versus 61% of the control patients, mainly as hypokinesia; tremor in 3% versus 11% and rigidity in 0 versus 19%. Psychic akathisia was found in 14% versus 40% and motor akathisia in 7% versus 29% of the patients, all differences significantly in favor of clozapine. Clozapine treated patients also had less neuroleptic-induced emotional indifference and depression, but more autonomic side effects than controls.
对长期使用氯氮平进行单一抗精神病药物治疗的精神分裂症患者（n = 100）以及使用奋乃静、三氟噻吨或氯哌噻吨治疗的患者（对照组，n = 100）进行了锥体外系副作用（EPS）（盲法评估）以及其他副作用和精神状态（非盲法评估）的评估。两组患者接受抗精神病药物治疗的总时长均为14年（中位数），目前使用抗精神病药物（氯氮平或对照药物）的时长为5年。因此，接受氯氮平治疗的患者此前接受传统抗精神病药物治疗的时长为9年（中位数）。该研究兼具回顾性（通过病历信息，氯氮平组为0.3 - 19年，对照药物组为0.3 - 24年）和前瞻性（1年，通过视频控制评估EPS）。与对照组患者相比，氯氮平治疗组迟发性运动障碍（TD）的患病率显著更低，尽管在接受该治疗之前，氯氮平组的TD患者更多（P < 0.05）。氯氮平组较低的TD水平与新病例诱导率较低有关（P < 0.001），并且与对照组相比，氯氮平组TD消失的趋势更明显（P = 0.07）。未患TD的氯氮平治疗患者开始使用氯氮平并停用传统抗精神病药物的年龄比患TD的患者更早。33%的氯氮平治疗患者出现帕金森氏体征，而对照患者中这一比例为61%，主要表现为运动迟缓；震颤发生率分别为3%和11%，肌强直发生率分别为0和19%。精神性静坐不能的发生率在患者中分别为14%和40%，运动性静坐不能的发生率分别为7%和29%，所有差异均显著有利于氯氮平组。氯氮平治疗的患者抗精神病药物所致情感淡漠和抑郁也较少，但自主神经副作用比对照组更多。
