Casey D E
Mental Illness Research, Education & Clinical Center, Veterans Administration Medical Center, and the Oregon Health Sciences University, Portland 97201, USA.
J Clin Psychiatry. 1998;59 Suppl 3:31-7.
Neuroleptics were the first modern class of pharmacotherapeutic agents available for the treatment of schizophrenia. Although they were effective in reducing florid psychotic symptoms, up to 90% of treated individuals subsequently developed extrapyramidal symptoms (EPS) (akathisia, dystonia, or parkinsonism), and about 20% developed tardive dyskinesia (TD). When clozapine became commercially available for treatment-resistant and treatment-intolerant (i.e., prone to EPS and TD) schizophrenic individuals, it became apparent that an antipsychotic need not induce motor side effects to be efficacious in reducing the symptomatology of schizophrenia. Sociodemographic, behavioral, and clinical predictors of TD are useful in identifying a subset of schizophrenic individuals who would benefit from treatment with clozapine, the prototype atypical antipsychotic whose efficacy and motor side effect profile are superior to those of chlorpromazine. This favorable motor side effect profile of clozapine contributes to improved patient outcomes by reducing noncompliance, substance abuse, and suicide, resulting in improved quality of life and savings on health care costs.
抗精神病药物是首批可用于治疗精神分裂症的现代药物治疗剂。尽管它们能有效减轻明显的精神病症状，但高达90%的接受治疗的个体随后出现锥体外系症状（EPS）（静坐不能、肌张力障碍或帕金森症），约20%的个体出现迟发性运动障碍（TD）。当氯氮平开始用于治疗难治性和不耐受性（即易出现EPS和TD）的精神分裂症患者时，很明显，一种抗精神病药物在减轻精神分裂症症状方面有效并不一定需要引起运动副作用。TD的社会人口统计学、行为和临床预测因素有助于识别一部分精神分裂症患者，他们将从氯氮平治疗中获益，氯氮平是典型的非典型抗精神病药物，其疗效和运动副作用情况优于氯丙嗪。氯氮平这种有利的运动副作用情况通过减少不依从性、药物滥用和自杀，改善了患者的治疗结果，从而提高了生活质量并节省了医疗费用。
