Sperner-Unterweger B, Czeipek I, Gaggl S, Geissler D, Spiel G, Fleischhacker W W
Innsbruck University Clinics, Department of Biological Psychiatry, Austria.
Br J Psychiatry. 1998 Jan;172:82-4. doi: 10.1192/bjp.172.1.82.
A 17-year-old boy suffering from a severe schizophrenic disorder of the paranoid type and mental retardation did not respond to treatment with typical antipsychotics, whereas under clozapine treatment he showed a favourable response. Discontinuation of clozapine led to an acute psychotic relapse. During clozapine treatment the patient developed severe neutropenia.
Due to the history of unsatisfactory response to traditional antipsychotics, clozapine treatment was continued despite white blood cell (WBC) decline. Concomitant treatment with G-CSF was followed by a rapid normalisation of WBC.
This case report is not intended to challenge the clinical practice of discontinuing clozapine upon the development of neutropenia/agranulocytosis, but rather to stimulate further research in the pathophysiology and clinical consequences of a clozapine rechallenge after a WBC decline, especially in patients with a rather complex symptomatology where no sufficient therapeutic results can be achieved with any other pharmacological intervention than clozapine.
一名17岁患有偏执型重度精神分裂症和智力障碍的男孩对典型抗精神病药物治疗无反应，而在氯氮平治疗下他表现出良好反应。停用氯氮平导致急性精神病复发。在氯氮平治疗期间，患者出现严重中性粒细胞减少。
由于对传统抗精神病药物反应不佳的病史，尽管白细胞（WBC）下降，仍继续氯氮平治疗。同时使用粒细胞集落刺激因子（G-CSF）治疗后，白细胞迅速恢复正常。
本病例报告并非旨在挑战在出现中性粒细胞减少/粒细胞缺乏症时停用氯氮平的临床实践，而是为了激发对白细胞下降后重新使用氯氮平的病理生理学和临床后果的进一步研究，特别是在症状相当复杂且除氯氮平外任何其他药物干预都无法取得足够治疗效果的患者中。
