对抗精神病药不良反应敏感者1例

1病例简介 患者，女，18岁，因“猜疑、耳闻人语4月，加重1周，总病程7年”第2次住院。患者2003年3月起病，表现为猜疑被害，曾在当地医院住院，诊断精神分裂症，予以氯氮平治疗，最高剂量为125mg／d，用药后第4周出现粒细胞下降（白细胞2．7×10^9／L，中性粒细胞1．24×10^9／L），而自动出院。

High vulnerability to adverse reactions toantipsychotics: a case report

This patient had antipsychotic-induced extrapyramidal symptoms and leucopenia. We use both psychiatric and neurological approaches to managing these side effects. We adopted the neurological approach to treating the extrapyramidal side-effects when the psychiatric approach proved ineffective. In addition, we found that prior leukopenia is a relative--but not absolute--contraindication for using clozapine： patients with a prior history of leukopenia （but not agranulocytosis） can be carefully re-challenged with clozapine while their blood counts are being closely monitored.