Spivak B, Mester R, Abesgaus J, Wittenberg N, Adlersberg S, Gonen N, Weizman A
Research Unit, Ness-Ziona Mental Health Center, Israel.
J Clin Psychiatry. 1997 Jul;58(7):318-22. doi: 10.4088/jcp.v58n0706.
Previous studies on the use of clozapine in neuroleptic-resistant chronic schizophrenic patients have demonstrated positive effects on tardive dyskinesia but were less conclusive about chronic akathisia and parkinsonism. The aim of the present study was to investigate the short-term (18 weeks) efficacy of clozapine in neuroleptic-resistant chronic schizophrenic patients with coexisting tardive dyskinesia, chronic akathisia, and parkinsonism.
Twenty chronic, neuroleptic-resistant schizophrenic patients with coexisting tardive dyskinesia, parkinsonism, and chronic akathisia were treated with clozapine. Assessment of tardive dyskinesia, parkinsonism, and chronic akathisia was made once weekly for 18 weeks with the Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Rating Scale for Extrapyramidal Side Effects, and Barnes Rating Scale for Drug-Induced Akathisia (BAS).
At the end of 18 weeks of clozapine treatment, improvement rates were 74% for tardive dyskinesia, 69% for parkinsonism, and 78% for chronic akathisia. A statistically significant reduction in the scores on the AIMS and Simpson-Angus Scale was achieved at Week 5 and on the BAS at Week 6 (p < .0001).
Relatively low doses of clozapine are effective for the treatment of neuroleptic-induced extrapyramidal syndromes in neuroleptic-resistant chronic schizophrenic patients. The relief of tardive dyskinesia, parkinsonism, and chronic akathisia in this group of patients occurs more rapidly than the reduction in psychotic symptoms. Disturbing, long-term extrapyramidal syndromes in chronic schizophrenic patients should be considered an indication for clozapine treatment.
既往关于氯氮平用于难治性慢性精神分裂症患者的研究已证实其对迟发性运动障碍有积极作用，但对于慢性静坐不能和帕金森症的结论性较弱。本研究的目的是调查氯氮平对伴有迟发性运动障碍、慢性静坐不能和帕金森症的难治性慢性精神分裂症患者的短期（18周）疗效。
20例伴有迟发性运动障碍、帕金森症和慢性静坐不能的慢性难治性精神分裂症患者接受氯氮平治疗。使用异常不自主运动量表（AIMS）、锥体外系副作用辛普森-安格斯评定量表以及药物所致静坐不能巴恩斯评定量表（BAS），在18周内每周对迟发性运动障碍、帕金森症和慢性静坐不能进行一次评估。
氯氮平治疗18周结束时，迟发性运动障碍的改善率为74%，帕金森症为69%，慢性静坐不能为78%。在第5周时AIMS和辛普森-安格斯量表评分有统计学意义的降低，在第6周时BAS评分有统计学意义的降低（p < .0001）。
相对低剂量的氯氮平对治疗难治性慢性精神分裂症患者的抗精神病药所致锥体外系综合征有效。该组患者迟发性运动障碍、帕金森症和慢性静坐不能的缓解比精神病性症状的减轻发生得更快。慢性精神分裂症患者令人困扰的长期锥体外系综合征应被视为氯氮平治疗的指征。
