Meltzer H Y
Pharmacology Division, Vanderbilt University School of Medicine, Nashville, Tenn, USA.
J Clin Psychiatry. 1998;59 Suppl 3:15-20.
Suicide is the major cause of premature death in patients with schizophrenia. Among these patients, 40% report suicidal thoughts, 20% to 40% make unsuccessful suicide attempts, and 9% to 13% end their lives by suicide. Traditional antipsychotic drugs undertreat many schizophrenic patients and can produce serious side effects, such as tardive dyskinesia. Clozapine is the only antipsychotic drug that has been shown in controlled clinical trials to be effective in reducing both positive and negative symptoms in schizophrenic patients who fail to respond to typical neuroleptic drugs. The potential decrease in suicide among schizophrenic patients treated with clozapine is estimated to be as high as 85%. Treatment with clozapine is cost-effective, and the significant decrease in the risk of suicide far outweighs the very low risk of mortality from agranulocytosis. Clozapine should be considered for treatment of both neuroleptic-resistant and neuroleptic-responsive schizophrenic patients who have persistent suicidal thoughts or behavior.
自杀是精神分裂症患者过早死亡的主要原因。在这些患者中，40%报告有自杀念头，20%至40%有过自杀未遂行为，9%至13%最终自杀身亡。传统抗精神病药物对许多精神分裂症患者治疗不足，且会产生严重副作用，如迟发性运动障碍。氯氮平是唯一一种在对照临床试验中被证明对那些对典型抗精神病药物无反应的精神分裂症患者，在减轻阳性和阴性症状方面都有效的抗精神病药物。据估计，接受氯氮平治疗的精神分裂症患者自杀风险的潜在降低高达85%。氯氮平治疗具有成本效益，自杀风险的显著降低远远超过粒细胞缺乏症导致的极低死亡风险。对于有持续自杀念头或行为的抗精神病药物抵抗型和抗精神病药物反应型精神分裂症患者，都应考虑使用氯氮平进行治疗。
