氯氮平台并利培酮与氯氮平治疗精神分裂症阴性症状的对照研究

目的 比较氯氮平合并利培酮与氯氮平对精神分裂症阴局限性症状的疗效。方法 ６０例长期住院的精神分裂症患者，分别接受氯氮平合并利培本呼氯氮平治疗，疗程８周，用ＢＰＲＳ，ＳＡＮＳ，ＳＡＰＳ，ＴＥＳＳ评定疗效和副反应。结果 氯氮平合并利培酮组在治疗后４周、８周ＳＡＮＳ评分较治疗前均有显著差异（Ｐ〈０．０１）；氯氮平组在治疗后８周ＳＡＮＳ评分与治疗前比较也有显著差异（Ｐ〈０．０５）。两组在治疗后４周、８周时     

氯氮平与氯丙嗪治疗精神分裂症的对照研究

为进一步验证氯氮平在治疗精神分裂症中的地位。方法对病程＜５年的１２２例首次住院的精神分裂症患者，采用分层随机法分为两组，分别首选氯氮平和氯丙嗪进行８周治疗。以ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ评定疗效，以ＴＥＳＳ评定副反应。结果治疗前后比较，两组ＢＰＲＳ、ＳＡＰＳ分均显著下降（Ｐ＜０．０１），ＳＡＮＳ分氯氮平组显著降低（Ｐ＜０．０１），氯丙嗪组无明显差异（Ｐ＞０．０５）；疗后氯氮平组的ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ总分均明显低于氯丙嗪组（Ｐ＜０．０１）；ＴＥＳＳ总分氯氮平组亦低于氯丙嗪组，且无锥体外系副反应。结论氯氮平确是一种十分有效且药物副反应并不多见的抗精神病药。在严密监测血象的情况下，氯氮平实际上可作为一个可供选择的治疗精神分裂症的第一线药使用。     

氯氮平药代动力学影响因素及血药浓度与临床效应的关系

为了探讨吸烟与性别对氯氮平药代动力学及稳态浓度的影响，以及氯氮平、去甲氯氮平稳态浓度与疗效、不良反应的关系，对３０例（吸烟男性１０例，不吸烟男性和女性各１０例）精神分裂症病人进行氯氮平药代动力学研究，对５８例精神分裂症病人于治疗第２、４、６、８周测定氯氮平和去甲氯氮平浓度，并评定简明精神病症状评定量表（ＢＰＲＳ）、阳性和阴性症状量表（ＳＡＰＳ、ＳＡＮＳ）及副反应量表（ＴＥＳＳ），分析血药浓度与疗效、不良反应的相关性。结果显示，吸烟者的氯氮平半衰期、达峰浓度和稳态浓度明显低于非吸烟者（Ｐ＜０．０１）。氯氮平、去甲氯氮平浓度和二者总浓度与ＴＥＳＳ呈显著正相关（Ｐ＜０．０１），与ＢＰＲＳ、ＳＡＰＳ和ＳＡＮＳ无显著相关，但有效组血药浓度高于无效组（Ｐ＜０．０５）。认为氯氮平血药浓度监测有一定临床意义，血药浓度以３５０～６００μｇ／Ｌ为宜     

抗精神病药对Ⅰ型,Ⅱ型精神分裂症疗效的对照研究

目的 前瞻性研究抗精神病药对Ⅰ型，Ⅱ型精神分裂症的疗效。方法 运用Ａｎｄｒｅａｓｅｎ等的阳性、阴性精神分裂症诊断标准，将研究病例划分为Ⅰ型，Ⅱ型精神分裂症。人组病例随机服用氯丙嗪，氯氮平，舒必利三种抗精神病药之一，疗程６周，在疗前及疗后２，４，６周运用ＢＰＲＳ，ＳＡＰＳ，ＳＡＮＳ，ＴＥＳＳ对每一病例进行一次评定。     

利培酮与舒必利治疗精神分裂症对照研究

目的：比较利培酮与舒必利对精神分裂症的临床疗效及对各症状群的作用特点,观察其副作用方法：将符合入级标准的精神分裂症患者随机分为利培酮与舒必利两组,用阳必瑟阴性症状量表（ＰＡＮＳＳ）、简明精神病评定量表（ＢＰＲＳ）、临床疗效总评（ＣＧＩ）、阴性症状量表（ＳＡＮＳ）和副反应量表（ＴＥＳＳ）等评定其疗效和副反应。结果：利培酮组疗效优于舒必利组,对阴性症状的效果更显著。ＴＥＳＳ总分两组间差异无显著性。结论     

利培酮合并氯氮平治疗精神分裂症阴性症状的对照研究

目的 研究利培酮合并氯氮平对精神分裂症阴性症状的疗效。方法 将６０例以阴性症状为主的精神分裂症住院患者随机分为两组，给予利培酮合并氯氮平和单用氯氮平治疗，疗程８周，用ＳＡＮＳ，ＢＰＲＳ、ＴＥＳＳ评定疗效和副反应。结果 利培酮合并氯氮平的疗效优于单一氯氮平，且起效较早，副反应发生率较低。结论 利培酮合并氯氮平治疗精神分裂症阴性症状的疗效较为理想。     

甲硫哒嗪与氯丙嗪治疗精神分裂症阳性症状对照研究

国产甲硫哒嗪与氯丙嗪分别治疗３７例精神分裂症患者，进行为期１２周的临床对照，比较了两药对阳性症状的疗铲及副反应。结果两组疗后ＢＰＲＳ及ＳＡＰＳ评分均显著下降，但无显著性差异。第２周的ＴＥＳＳ总分，第２和８周的植物神经系副反应评分，疗后各周的神经系副反应评分氯丙嗪组显著高于甲硫哒嗪组，而疗后第１，２周的心血管系副反应评分甲硫哒嗪组则显著高于氯丙嗪组。     

甲硫哒嗪与舒必利治疗精神分裂症阴性症状的随机对照

探索甲硫哒嗪对精神分裂症阴性症状的疗效与不良反应。方法对３９例住院精神分裂症病人，用甲硫哒嗪与舒必利随机对照，采用ＢＰＲＳ，ＳＡＮＳ，ＳＡＰＳ和ＴＥＳＳ及临床疗铲总评进行评定。甲硫哒嗪与舒必利疗效基本相似，副反庆也无明显差异。甲硫哒嗪对精神分裂症阴性症状亦有较好疗效。     

国产硫利哒嗪和氯氮平治疗精神分裂症双盲对照研究

探讨硫利哒嗪（甲硫哒嗪）治疗精神分裂症阴性、阳性症状的疗效和副反应。按双盲方式以硫利哒嗪和氯氮平治疗精神分裂症各２０例，用ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ观察疗效，以ＴＥＳＳ记录副反应。用方差分析，ｔ检验、卡方检验和Ｒｉｄｉｔ检验进行分析比较。两组疗效相当，副反应有所不同，硫利哒嗪的副反应较轻微。     

卡马西平与氯氮平治疗精神分裂症双盲对照研究

用卡马西平、氯氮平对６３例男性精神分裂症进行了为期８周的双盲对照研究，采用ＢＰＲＳ、ＳＡＰＳ、ＳＡＮＳ、ＴＥＳＳ进行评定，结果氯氮平有效率为９４．１２％，卡马西平有效率为７２．４１％，差异有显著意义（Ｐ＜０．０５）。     

Infection-associated clozapine toxicity

Three case vignettes are presented documenting the rise in serum clozapine that occurred at a time of acute infection in these patients. The literature on this phenomenon is scant. The physiological processes that occur in the acute phase of the inflammatory response are summarized and provide an explanation of how clozapine levels may rise in response to infection. The risk of clozapine toxicity occurring in association with infections is highlighted.     

Optimizing clozapine treatment

Nielsen J, Damkier P, Lublin H, Taylor D. Optimizing clozapine treatment. Objective: Clozapine treatment remains the gold standard for treatment‐resistant schizophrenia, but treatment with clozapine is associated with several side‐effects that complicate the use of the drug. This clinical overview aims to provide psychiatrists with knowledge about how to optimize clozapine treatment. Relevant strategies for reducing side‐effects and increasing the likelihood of response are discussed. Method: Studies of clozapine available in MEDLINE were reviewed. Results: A slow up‐titration of clozapine is recommended in order to reach the optimal dosage of clozapine and diminish the risk of dose‐dependent side‐effects. Particularly, in case of partial response or non‐response, the use of therapeutic drug monitoring of clozapine is recommended. Plasma levels above the therapeutic threshold of 350–420 ng/ml are necessary to determine non‐response to clozapine. To ease the burden of dose‐dependent side‐effects, dose reduction of clozapine should be tried and combination with another antipsychotic drug may facilitate further dose reduction. For most side‐effects, counteracting medication exists. Augmentation with lamotrigine, antipsychotics, or electroconvulsive therapy may be beneficial in case of partial response to clozapine. Conclusion: Treatment with clozapine should be optimized in order to increase the rate of response and to minimize side‐effects, thus diminishing the risk of discontinuation and psychotic relapse.     

Reason for clozapine cessation

Pai NB, Vella SC. Reason for clozapine cessation. Objective: Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment‐resistant or refractory schizophrenia. The gold standard for treatment of refractory schizophrenia is clozapine. However, a significant number of patients cease clozapine therapy; therefore this study explores patient’s motives for cessation. Method: The motives for cessation and duration of clozapine treatment from a retrospective database of 151 patients with schizophrenia or schizo‐affective disorder who had ceased clozapine once or more were reviewed, with the motives for cessation coded. The general motives for cessation were non‐compliance, own decision, medical, poor response and other. In addition, the medical reasons for cessation were further codified: cardiac complications, neutropenia, fevers, other side effects and pregnancy. Results: The majority of patients ceased clozapine owing to non‐compliance with medical protocols or citing their own decision. Approximately half ceased after a period of 6 months or less. Seventeen per cent of patients ceased owing to medical reasons, with the largest proportions discontinuing treatment because of other side effects or neutropenia. Conclusion: Future research should seek to further investigate why patients decide to be non‐compliant and formulate their own decision to cease treatment, as this will facilitate strategies to promote adherence amongst these two groups that are potentially the most amenable to change.