精神病患者精神药物使用情况对比分析

目的:了解中山市埠湖医院住院精神病患者精神药物使用情况.方法:以1994年9月15日和2000年3月15日为两个调查日,用自制调查量表调查当日用药情况,分别调查154例(旧组)和242例(新组).结果:旧组的用药以氯丙嗪(68.18%)和卡马西平(20.78%)为最常用,以后依次为奋乃静、氯氮平、舒必利、碳酸锂和三氟拉嗪.新组以氯丙嗪(66.1%)和氯氮平(27.3%)为最常用,以后依次为舒必利、利培酮、奋乃静、卡马西平、氟哌啶醇和碳酸锂.结论:氯丙嗪和氯氮平以其有效、价廉成为该院最常用的精神药物,利培酮以其副作用小、依从性好成为该院常用药物之一.     

住院精神病患者抗精神病药应用现状调查

目的 了解住院精神病患者抗精神病药的应用情况，为临床用药提供参考。方法 抽样调查本院2003年6月508例住院精神病患者抗精神病药应用情况。结果 本次调查共涉及423例患者24种治疗方案，其中单用1种抗精神病药的治疗方案有7种246例(58．15％)，联用2种抗精神病药的有15种173例(40．90％)，联用3种抗精神病药的有1种2例(0．47％)。抗精神病药治疗方案居前5位的依次为：氯氮平、氯氮平 碳酸锂、氯氮平 舒必利、氯丙嗪和利培酮。抗精神病药使用率占前5位的是氯氮平(51．9％)、利培酮(19．29％)、舒必利(17．12％)、氯丙嗪(15．35％)和奋乃静(9．05％)。结论 本院单用1种抗精神病药的治疗方案占主导地位，氯氮平的使用率为第1位。     

抗精神疾病药物的临床应用调查与药学研究

目的研究分析了解目前辽宁辽阳地区部分医院精神分裂症患者的用药情况。方法采用自制的调查表调查辽宁辽阳地区部分医院精神分裂症患者用药情况,共调查300例。结果住院患者的用药以氯氮平(39.33%)居用药频度首位,其次为氯丙嗪、利培酮、舒必利、氟哌啶醇。结论由于氯氮平和氯丙嗪较为有效、安全和价廉,故仍为临床最常用的抗精神病药物。     

儿童精神分裂症住院患者不同年代用药比较

目的探讨儿童精神分裂症住院患儿不同年代使用精神药物的变化趋势.方法回顾性分析相隔15年,1年内住院的儿童精神分裂症患儿病例资料共306例,比较两组使用精神药物情况、疗效和不良反应.结果15年前组用药前三位为氯丙嗪、奋乃静、舒必利,以典型抗精神病药为主;15年后组用药前三位为利培酮、氯氮平、奎硫平,以非典型抗精神病药为主.结论儿童精神分裂症住院患儿临床用药由典型抗精神病药转向非典型抗精神病药,利培酮、氯氮平等非典型抗精神病药可作为儿童精神分裂症的首选药物.     

初诊精神分裂症患者首选精神药物状况分析

目的：了解初诊精神分裂症患者首次选用精神药物情况。方法：采用自制精神药物使用表格按分层抽样法调查全年首发精神分裂症患者首次使用精神药物（PD）情况,作1a后应用追踪分析。结果：684例患者中,单用抗精神病药（APD）69．4％,2,3种APD合并者分别占24．3％,6．3％;APD使用频率分别是氯氮平（28．7％）、奋乃静（21．4％）、利培酮（20．2％）,舒必利（16．2％）,氯丙嗪（8．2％）、其他（5．3％）,折合氯丙嗪日平均最高剂量约328mg;苯海索预防性用药效多（45．2％）,APD合并抗焦虑药（48．2％）,抗抑郁药（17．9％）,合并抗焦虑药＋抗抑郁药（5．1％）,抗躁狂药（3．3％）;1a后追踪首选APD使用率64．8％,换选药物主要以氯氮平、利培酮为主、利培酮为主,合并用药明显减少;非典型抗精神病药使用频率逐渐增高,已成为精神分裂症治疗的主要首选药物。结论：对初诊精神分裂症患者次药方案基本合理。     

住院精神病人精神药物使用情况调查

目的：了解精神病人用药现状，为临床用药提供一定依据。方法：对某精神病医院373例住院精神病人用药情况进行时点调查。结果：使用频率最高的抗精神病药物依次为氯氮平、舒必利、利培酮、氟哌啶醇等，单用抗精神病药物257例（68．90％），合并用抗精神病药物85例（22．8％）。结论：住院精神病人以精神分裂症为主，最常用为非典型抗精神病药物，单一使用为主，其它典型抗精神病药物使用频率已下降。     

氯丙嗪和氯氮平临床副作用200例分析

氯丙嗪及氯氮平是精神科常用的广谱抗精神病药物，并以其疗效稳定，作用迅速而乐于被大多数患者接受。本文研究200例服用氯丙嗪及氯氮平的患者在心电图、脑电图、血象及肝脏超的检查结果，分析如下。1研究对象病例随机选自1994年1月至1996年12月在我院的住院患者200例，其中以氯丙嗪或氯氮平治疗各100例（以下称氯丙嗪组及氯氮平组）。氯丙嗪及氯氮平均采用上海黄河制药厂生产的同一批号产品，氯丙嗪每片50mg，氯氮平每片25mg。全部患者均符合CCMD－2—R诊断为精神分裂症，年龄最小17岁，最大53岁，平均26.95±80岁。病程最短5d，最长20Y…     

儿童精神分裂症住院患者临床用药比较

目的:探讨儿童精神分裂症住院患者近15年使用精神药物变化趋势及临床用药的合理性.方法:对15年前后306例住院儿童精神分裂症患者的病例资料进行回顾性分析,比较两组使用精神药物情况、疗效和不良反应(ADR).结果:15年前组(A组)用药前3位为氯丙嗪、奋乃静、舒必利,以典型抗精神病药(APD)为主;15年后组(B组)用药前3位利培酮、氯氮平、奎的平,以非典型APD为主,B组单一用药显著高于A组(P＜0.05),ADR低于A组(P＜0.05),两组疗效及不同用药方案疗效差异无显著性(P＞0.O5).结论:B组用药基本合理,提示儿童精神分裂症用药尽量减少联合用药,可把非典型APD利培酮、氯氮平作为儿童精神分裂症的首选药物.     

氯氮平所致糖尿病临床分析

目的：观察氯氮平所致糖尿病，方法：样本选自1991－2000年住院单用氯氮平患者9388例，结果：氯氮平引起糖尿病12例，结论：氯氮平所致糖尿病少见，发生率仅为0．128％，用药期间尖定期查血糖，尿糖，如发现异常应及时停药并做相应处理。     

氯氮平治疗与糖耐量异常的关系探讨

目的：探讨氯氮平治疗与糖耐量异常的关系。方法：将空腹血糖7．0～11．1mmol／L作为糖耐量异常(IGT)的标准。选择172例住院精神分裂症病人,按所服药物分为氯氮平组与对照组氯丙嗪组,比较两组IGT发生率的差异并对氯氮平组的相关资料进行分析。结果：氯氮平组中IGT发生率为12．94％,显著高于氯丙嗪组,氯氮平所致IGT与患者年龄、家族史显著相关。结论：对服用氯氮平的患者进行血糖监测是必要的,尤其是年龄大、有糖尿病家族史者。对合并糖尿病的精神分裂症患者应慎用氯氮平。     

Effects of sulpiride and chlorpromazine on regional cerebral glucose metabolism in schizophrenic patients as determined by positron emission tomography

Positron emission tomography (PET) was used to determine regional brain glucose metabolism in schizophrenic patients (n=17) before and during neuroleptic treatment. The patients had not been treated with neuroleptics for at least 3 weeks before the first study. All suffered from acute psychotic symptoms and were hospitalized to obtain neuroleptic treatment. After determination of regional brain metabolism without neuroleptic treatment, 11 patients were treated with sulpiride (800 mg/day) and 6 patients were treated with chlorpromazine (400 mg/day) over 5–6 weeks before the second PET investigation. The control group consisted of seven healthy male volunteers, also investigated twice 5 weeks apart. The PET investigation was made with the subject in a resting state. The tracer was uniformly labelled ¹¹C-glucose. The metabolism was determined bilaterally in 15 brain regions cortical, as well as central regions. Metabolic rates differed among the groups. The sulpiride group had lower metabolic rates than the controls and the schizophrenic patients later treated with chlorpromazine. The sulpiride group, in which absolute metabolic rates were determined, were clinically more autistic and chronic than the chlorpromazine group. It was proposed that these facts could explain the lower metabolic rates in the sulpiride group. A significant change in metabolism in relation to drug treatment was only found in one brain region. The selective D2-receptor antagonist sulpiride increased the metabolic rate in the right lentiform nucleus in comparison with the patients treated with chlorpromazine and the controls. Likewise, relative metabolic rates were increased only in the right lentiform nucleus. Negative correlations between intensity of clinical symptoms and metabolism indicated that emotional tone and drive were related to brain metabolism. No correlations were found between drug concentrations and metabolism or clinical symptoms.     

哌泊噻嗪氯氮平治疗精神分裂症阴性症状26例

目的;研究哌泊噻嗪合并氯氮平对阴性症状的疗效。方法：将５０例以阴性症状为主的精神分裂症患者随机分为氯氮平合并哌泊噻嗪组２６例和单用氯氮平组２４例,采用临床疗效评定,简明精神病量表（ＢＰＲＳ）,阴性症状量表（ＳＡＮＳ）。结果：哌泊噻嗪合并氯氮平组显效率５８．０％,ＳＡＮ减分率６６．０％,氯氮平组显效率３５．０％,ＳＮＡＳ减分率５３．４％,经ｕ检查,两者均差异显著（Ｐ〈０．０５）。结论：哌泊噻嗪合并氯     

Effect of switching carbamazepine to oxcarbazepine on the plasma levels of neuroleptics. A case report

Carbamazepine was switched to its 10-keto analogue oxcarbazepine among six difficult-to-treat schizophrenic or organic psychotic patients using concomitantly haloperidol, chlorpromazine or clozapine. This change resulted within 2–4 weeks in the 50–200% increase in the plasma levels of these neuroleptics and the appearance of extrapyramidal symptoms. None of the patients showed any clinical deteriotation during the following 3–6 months. The results of this case report support the idea that in contrast with carbamazepine oxcarbazepine does not induce the hepatic microsomal enzyme systems regulating the inactivation of antipsychotic drugs.     

Differential effect of neuroleptic drugs on dopamine turnover in the extrapyramidal and limbic system.

In gallamine-immobilized cats, the caudate nucleus and the nucleus accumbens septi were perfused by means of a push-pull cannula and dopamine was measured in the perfusate. Chlorpromazine (10 mg kg(-1)) and clozapine (20 mg kg(-1)), administered intravenously, enhanced the release of dopamine. The effect of chlorpromazine was similar in both regions whereas that of clozapine was more pronounced in the nucleus accumbens than in the caudate nucleus. Furthermore, in the rat, sulpiride, clozapine and thioridazine increased the homovanillic acid concentration in striatum and limbic system to a similar extent. However, following probenecid administration, the net effect of these drugs on homovanillic acid accumulation was more marked in the limbic system than in the striatum whereas haolperidol and chlorpromazine had a similar effect in the two regions. It is concluded that, in contrast to haloperidol and chlorpromazine, sulpiride, clozapine and thioridazine may preferentially affect the limbic dopaminergic transmission. This possibly accounts for the fact that sulpiride, clozapine and thioridazine display an antipsychotic action and yet cause less extrapyramidal side effects than haloperidol and chlorpromazine.     

Differential effects of neuroleptic drugs on the delayed matching-to-sample performance of pigeons

The effects of clozapine, thiothixene, sulpiride, chlorpromazine and loxapine were examined in pigeons responding under a delayed matching-to-sample (DMTS) procedure using 0-, 2- and 8-sec delay intervals. Chlorpromazine (3-100 mg/kg), thiothixene (0.03-1.7 mg/kg), clozapine (0.1-5.6 mg/kg) and loxapine (0.1-10 mg/kg) produced dose-related decreases in the percent of correct responses (accuracy). With the exception of chlorpromazine, the relative magnitude of the accuracy-decreasing effects were unrelated to the length of the delay interval and the nondrug levels of accuracy. In contrast to these accuracy-decreasing effects, sulpiride (3-300 mg/kg) failed to decrease accuracy across the range of doses evaluated. Chlorpromazine, loxapine and clozapine increased response rates at low doses and then decreased response rates as the dose was increased. Thiothixene and sulpiride only decreased response rates in a dose-dependent fashion. The order of potency for the rate-suppressing effects of these drugs was thiothixene greater than clozapine = loxapine greater than chlorpromazine greater than sulpiride. The results of the present investigation suggest that, despite similar dopamine antagonist properties, neuroleptics produce qualitatively different effects in pigeons responding under DMTS procedures.     

Successful treatment of urinary incontinence with clozapine in a schizophrenic patient

There is evidence that urinary incontinence (UI) can develop without any organic aetiology as a direct side effect of typical antipsychotic medication. Clozapine was administered to a chronic schizophrenic patient with UI who was refractory to typical antipsychotic medication. After various laboratory and functional tests, UI was demonstrated to be unrelated to any organic aetiology. UI was monitored throughout the study as frequency (wetting the bed) per day and night. The Brief Psychiatric Rating Scale (BPRS) was also rated. Clozapine (dose-dependently) reduced both the BPRS score and frequency of UI, which were refractory to trifluoperazine and sulpiride. This is the first report of a dramatic resolution of UI in a schizophrenic patient after clozapine treatment. It is suggested that preference should be given to clozapine in such cases, since various other antipsychotic medications were ineffective and in some cases worsened the existing UI.     

Relapse following clozapine withdrawal: effect of neuroleptic drugs and cyproheptadine

The objective of this study was to report the effect of the slow withdrawal of clozapine from 19 patients withneuroleptic-responsive schizophrenia at the end of a 2-year clinical trial of clozapine and to compare this with the results of naturalistic discontinuation of clozapine treatment in 64neuroleptic-resistant schizophrenic patients. Nineteen neuroleptic-responsive schizophrenic patients who received clozapine were withdrawn from clozapine by tapering it over 3-week period with and without the addition of a typical neuroleptic. Fifteen of the 19 neuroleptic-responsive patients experienced the return of psychotic symptoms during or after the clozapine taper, which were most severe in the ten patients in whom the withdrawal of clozapine was carried out without prior addition of neuroleptic treatment. Addition of a neuroleptic prior to clozapine withdrawal prevented the emergence of positive symptoms during clozapine withdrawal in each of eight patients. Nevertheless, psychotic symptoms emerged, usually within a week after discontinuing clozapine, in six of the eight patients. Neuroleptic treatment, with or without an anticholingergic drug, was much less effective in treating positive symptoms in these patients immediately after the clozapine withdrawal than it had been 2 years previously. Cyproheptadine, a non-selective serotonin receptor antagonist, augmented the antipsychotic effect of neuroleptics in each of four patients who relapsed following withdrawal from clozapine and relieved extrapyramidal symptoms in a fifth patient. The frequency of relapse following withdrawal of clozapine in 64 neuroleptic-resistant patients was significantly lower (25/64, 39.1%) than in the neuroleptic-responsive patients.     

A Kinetic Model for Simultaneous Fit of Clozapine and Norclozapine Concentrations in Chronic Schizophrenic Patients during Long-Term Treatment

OBJECTIVE: The pharmacokinetic profiles of clozapine and its main metabolite, norclozapine, were investigated in 18 chronic schizophrenic inpatients during long-term treatment. PATIENTS: Patients received stable daily doses (between 300 and 900mg) for at least 1 month. Plasma drug concentrations were determined by high performance liquid chromatography. The pharmacokinetic parameters were calculated from both noncompartmental and compartmental approaches with zero-order input rate using a kinetic model for simultaneous fit of clozapine and norclozapine (active metabolite) concentrations. RESULTS: Large interpatient variations in pharmacokinetic parameters of the two drugs were observed. Plasma clozapine concentration peaked on average at 2 hours. The mean elimination rate constants from compartments 1 (k(10)) and 2 (k(20 ), elimination rate constant of norclozapine) were 0.087 and 0.156h(-1), respectively. The rate of formation of norclozapine, k(12), averaged 1.25h(-1). The mean fraction of the administered dose converted to norclozapine was estimated to be 66%. The apparent clearance of clozapine (CL/F) averaged 44.7 L/h and the volume of distribution (V(c)/F) was 7.00 L/kg. The pharmacokinetics of clozapine after multiple doses were linear over the range of clozapine plasma concentrations of 145 to 1411 microg/L. CONCLUSION: This is the first study assessing the pharmacokinetic profile of clozapine plus norclozapine in plasma during long-term treatment. This pharmacokinetic model can be used to determine the population pharmacokinetic parameters of clozapine and norclozapine in order to optimise individual dosage regimens using a Bayesian methodology.     

住院男性精神分裂症合并高血糖患者的精神症状分析

目的了解住院男性精神分裂症患者的高血糖发生率,并对其精神症状进行分析。方法选择259例男性精神分裂症患者,测定其空腹血糖,并用两种方法判断结果。同时给予阳性与阴性症状量表(PANSS)评定其精神症状。结果 259例住院男性精神分裂症患者高血糖的发生率为12.4%;男性精神分裂症合并高血糖患者的年龄、病程、阴性症状均高于血糖正常精神分裂症患者,差异有统计学意义(t值分别为4.205,5.724,4.982,P值均<0.01)。Logistic回归显示病程、阴性症状为高血糖的患病危险因素。结论阴性症状在住院男性精神分裂症合并高血糖患者中较为突出,应予以关注。