Shiloh R, Zemishlany Z, Aizenberg D, Radwan M, Schwartz B, Dorfman-Etrog P, Modai I, Khaikin M, Weizman A
Geha Psychiatric Hospital, Rabin Medical Center, Petah Tiqva, Israel.
Br J Psychiatry. 1997 Dec;171:569-73. doi: 10.1192/bjp.171.6.569.
We hypothesised that a combined regimen of clozapine, a relatively weak D2-dopaminergic antagonist, and sulpiride, a selective D2 blocker, would demonstrate a greater antipsychotic efficacy by enhancing the D2 blockade of clozapine.
Twenty-eight people with schizophrenia, previously unresponsive to typical antipsychotics and only partially responsive to current treatment with clozapine, received, double-blind, 600 mg/day sulpiride or placebo, in addition to an ongoing clozapine treatment. The clinical status was evaluated before, during, and at the end of 10 weeks of sulpiride addition using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, and Hamilton Rating Scale for Depression.
The clozapine-sulpiride group exhibited substantially greater and significant improvements in positive and negative psychotic symptoms. About half of them, characterised by a younger age and lower baseline SAPS scores, had a mean reduction of 42.4 and 50.4% in their BPRS and SAPS scores, respectively.
A subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.
我们假设，氯氮平（一种相对较弱的D2多巴胺能拮抗剂）与舒必利（一种选择性D2阻滞剂）联合用药方案，通过增强氯氮平的D2受体阻断作用，将显示出更大的抗精神病疗效。
28例对典型抗精神病药物无反应且仅对当前氯氮平治疗部分有效的精神分裂症患者，在持续使用氯氮平治疗的基础上，接受为期10周的双盲治疗，其中一组每天服用600毫克舒必利，另一组服用安慰剂。在添加舒必利治疗前、治疗期间及治疗10周结束时，使用简明精神病评定量表（BPRS）、阳性症状评定量表（SAPS）、阴性症状评定量表和汉密尔顿抑郁评定量表对临床状态进行评估。
氯氮平-舒必利组在阳性和阴性精神病症状方面有显著更大的改善。其中约一半患者年龄较轻且基线SAPS评分较低，其BPRS和SAPS评分平均分别降低了42.4%和50.4%。
慢性精神分裂症患者亚组可能从氯氮平联合舒必利治疗中显著获益。
