住院精神分裂症患者药物使用现况调查

目的调查2013年5月在上海交通大学医学院附属精神卫生中心住院的精神分裂症患者药物使用情况。方法本次研究为横断面研究,以2013年5月22日为时点调查日,对我院802例精神分裂症住院患者使用自制调查表进行药物使用的现况调查。结果（1）单一使用抗精神病药物患者比例为43．45％。（2）抗精神病药物使用频度前5位：氯氮平421例（52．56％）,奥氮平225例（28．09％）,利培酮196例（24．47％）,阿立派唑158例（19．73％）,奎硫平126例（15．73％）。（3）精神分裂症患者中合并糖尿病的比例为21．70％,且年龄因素、是否使用氯氮平治疗与糖尿病的发生有相关性。（4）精神分裂症患者中合并高血压的比例为33．04％,且年龄因素与高血压的发生有相关性。结论我院单一用药比例低,氯氮平的使用率高,抗精神病药物的治疗仍需进一步规范。精神分裂症患者中合并糖尿病、高血压的比例高,年龄因素可增加糖尿病、高血压的发生率,服用氯氮平可增加糖尿病的发生率。     

氯氮平引起粒细胞缺乏的Meta分析

目的 进一步认识氯氮平与其他抗精神病药物致粒细胞缺乏的差异。方法 按标准对收集的,关于氯氮平与其他抗精神药致粒细胞缺乏的对照研究论文结果作Ｍｅｔａ分析。结果 （１）氯氮平与其他抗精神病药物导致细胞缺乏有非常显著性差异;（２）氯氮平引起粒细胞缺乏的危险性是其他抗精神病药物的８．８倍;（３）病因学分数：ＥＦ暴露因素＝０．８８,即氯氮平治疗组中出现粒缺者,８８％是由氯氮平引起的ＥＦ总体＝０．８８,即在全     

门诊抗精神病药使用情况的调查

为了解门诊病人抗精神病药（ＡＰＤ）使用频度、治疗方案、药物副反应和疗效，采用分层随机方法抽取４８１例病人，用半定式表格填写自制的精神药物使用调查表。结果发现，门诊使用ＡＰＤ前３位药品为氯丙嗪、氯氮平及奋乃静，治疗方案前３位为氯丙嗪、氯氮平及氯丙嗪＋氯氮平；发现治疗剂量＜４００ｍｇ／ｄ组病人，药物副反应轻，疗效亦较好；单一治疗组副反应较合并及联合用药组轻，且疗效明显较好。有５３．６％的病人使用安坦，其中３７．２％的病人为预防性使用安坦。作者认为门诊病人尽量单一应用ＡＰＤ治疗，维持治疗剂量宜在４００ｍｇ／ｄ以下，不主张长期或预防性使用安坦。     

抗精神病药物与血糖调节异常的短期监测

目的探索抗精神病药物与血糖代谢的相关性，慎重选择药物。方法对住院的151例精神分裂症患者，再短期观察3个月，进行自身对照，分析患者入组时和继续原药治疗3个月后的空腹血糖变化特点。结果短期服用抗精神病药物后，对胰岛功能的影响不明显，而年龄大、病程长，血糖浓度有明显增加趋势；体重指数与血糖浓度呈正相关；氯氮平组的血糖浓度最高。结论使用氯氮平时，应定期监测血糖，糖尿病或糖耐量下降（IGT）者应避免使用氯氮平。     

氯氮平对老年精神病患者糖、脂代谢的影响

目的 了解氯氮平对老年精神病患者糖、脂代谢的影响。方法回顾性分析36例接受8周氯氮平治疗的老年精神病患者血糖、血脂变化及血糖异常率、胆固醇异常率和甘油三脂异常率。结果接受氯氮平治疗8周后血糖、胆固醇和甘油三脂水平均比治疗前显著升高（P〈0．01）；治疗8周末血糖异常者占27．8％，胆固醇异常者占16．7％，甘油三脂异常者占55．5％。结论氯氮平对老年精神病患者糖脂代谢有明显影响，可能会增加Ⅱ型糖尿病、高血压、冠心病等疾病发生的风险。     

抗精神病药物对心电图的影响（附560例分析）

报告抗精神病药物对心电图的影响。５６０例中单用氯丙嗪１３８例（２４．６％），剂量２００～６００ｍｇ／日．平均４１７．４ｍｇ／日．氯丙嗪合并氯氮平９５例（１７．０％），氯丙嗪与其他精神药物以及其他单用或合用者３２７例（５８．４％）．在入院时，入院后１月和２月各做一次心电图。结果首次检查窦速者１０３例次（１８．４％）．窦缓７例次（１．３％），部分Ｔ波和Ｔ波改变５１例（９．１％），Ｔ波和ＳＴ段改变１８例次（３．２％），在第２、３次检查时心电图改变有所减少。     

抗精神药物对心电图的影响（附560例分析）

报告抗精神病药物对心电图的影响。５６０例中单用氯丙嗪１３８例（２４．６％），剂量２００￣６００ｍｇ／日，平均４１７．４ｍｇ／Ｈ，氯丙嗪合并气氯氮平９５例，氯丙嗪与其他精神药物以及其他单用或合用者３２７例（５８．４％），在入院时，入院后１月和２月各做一次心电图。结果首次检查窦速者１０３例次（１８．４％），窦缓７例次（１．３％），部分Ｔ波和Ｔ波改变５１例，Ｔ波和ＳＴ段波改变１８例次，在第２，３次检查时     

氯氮平治疗边缘人格障碍

氯氮平治疗边缘人格障碍【英】／ＦｒａｎｋｅｎｂｕｒｇＦＲ…ＣｏｍｐｒｅＰｓｙｃｈｉａｔｒｙ．－１９９３，３４（６）；－４０２～４０５某些边缘性人格障碍（ＢＰＤ）病人可伴有明显的精神症状，并且用一般抗精神病药物治疗效果不理想。本文报告同时有非典型精神障...     

氯氮平致药源性强迫症状的调查

目的：了解在应用抗精神病药物治疗精神分裂症过程中出现的强迫症状,是否为药物所致。方法：对上海市精神卫生中心分部某一病区所有正在应用抗精神病药物治疗的住院精神分裂症病人,以Y－BOCS及MSCPOR量表评定,凡发现有强迫症状,予以减药直至停药,观察强迫症状的变化,以期证其与抗精神病药物的关系。结果：共调查430名,发现确实系抗精神病药物所强迫症状者4例,均为服用氯氮平者,占服氯氮平病例总数,发现确实系抗精神病药所致强迫症状者4例,均为服用氯氮平者,占服氯氮平病例总数1．41％。结论氯凿可产生强迫症状,在临床应用时应予注意。     

503例住院精神分裂症患者共患糖尿病的调查

目的：调查住院精神分裂症患者糖尿病的发生情况及相关因素。方法：对503例住院精神分裂症患者进行病历资料回顾，体格检查及血生化检测。结果：住院精神分裂症患者糖尿病的时点患病率为12．9％，显著高于一般人群的3．21％（OR=4．48，CI=3．43～5．84，P〈0．01）。40—49岁的患者中糖尿病患病率增高明显（14．6％vs．3．02％，OR=5．51，CI=3．49～8．70，P〈0．01）。糖尿病发生与年龄、体质量超重及腹型肥胖有关。糖尿病组患者的病程比非糖尿病患者长（Z=-6．989，P〈0．01），接受目前抗精神病药物治疗时间也比非糖尿病患者长（Z=-4．794，P〈0．01）。氯氮平新发糖尿病患病率高于利培酮组与经典药物组（P〈0．01），利培酮组与经典药物组患病率差异无统计学意义（P〉0．05）。结论：住院精神分裂症患者糖尿病患病率高于一般人群，与患者年龄、体质量超重、病程及抗精神病药治疗时间有关。氯氮平比利培酮及经典药物可能更容易导致糖尿病的发生。     

住院精神分裂症患者糖耐量减低调查

目的：了解住院精神分裂症患者糖耐量减低（IGT）的发生率及其相关因素。方法：对上海市普陀区精神卫生中心住院的精神分裂症患者作调查,测定其代谢指标,IGT采用《中国2型糖尿病防治指南2007》诊断标准。结果：共入组286例,住院精神分裂症患者IGT的发生率为27.3%（78/286）,男性为27.6%（53/192）;女性为26.6%（25/94）。年龄、三酰甘油、收缩压、舒张压、是否服用氯氮平与IGT患病率有关（P〈0.05）。Logistic回归发现三酰甘油、年龄及收缩压为IGT的患病危险因素。结论：住院精神分裂症患者中存在较高的IGT发生率,应予以关注。     

Diabetes mellitus among parkinsonian patients treated chronically with clozapine

Clozapine is the gold standard treatment for Parkinson's disease (PD) psychosis based on double blinded, placebo controlled trials, and has also been shown to alleviate tremor and dyskinesia. There is accumulating data suggesting that clozapine may be associated with increased frequency of diabetes mellitus (DM) compared to conventional neuroleptic drugs in treating schizophrenia. Forty-four predominantly geriatric parkinsonian subjects on clozapine for psychosis, tremor or dyskinesia, on an average dose of 50.6 mg/d for a mean duration of 41 months were reviewed. The prevalence of DM in this cohort was 18.1% (8/44). This rate was similar to that reported in the aged-matched general population (prevalence = 19.3% for ages > or = 60 years). In this small study, parkinsonian patients on long-term, low dose clozapine were not at increased risk for developing DM. Larger controlled prospective studies are needed to confirm this.     

Motoric neurological soft signs and psychopathological symptoms in schizophrenic psychoses

Motoric neurological soft signs (NSS) were investigated by means of the Brief Motor Scale (BMS) in 82 inpatients with DSM-III-R schizophrenic psychoses. To address potential fluctuations of psychopathological symptoms and extrapyramidal side effects, patients were examined in the subacute state, twice at an interval of 14 days on the average. NSS were significantly correlated with severity of illness, lower social functioning, and negative symptoms. Modest, but significant correlations were found between NSS and extrapyramidal side effects as assessed on the Simpson-Angus Scale. Neither the neuroleptic dose prescribed to the patient, nor scores for tardive dyskinesia and akathisia were significantly correlated with NSS. Moreover, NSS scores did not significantly differ between patients receiving clozapine and conventional neuroleptics. Patients in whom psychopathological symptoms remained stable or improved over the clinical course showed a significant reduction of NSS scores. This finding did not apply to those patients in whom psychopathological symptoms deteriorated. Our findings demonstrate that NSS in schizophrenic psychoses are relatively independent of neuroleptic side effects, but they are associated with the severity and persistence of psychopathological symptoms and with poor social functioning.     

Blood biogenic amines during clozapine treatment of early-onset schizophrenia

Summary The aims of this investigation were to evaluate long-term and short-term effects of clozapine-treatment on plasma biogenic amines and psychopathology measures in adolescents with schizophrenia (DSM-III-R criteria). The long-term study was conducted in a study sample of 40 young patients (age 14–22 years) following a mean of 3.4 years of neuroleptic treatment. During the study, 20 patients received clozapine, and the other 20 patients were treated with standard neuroleptic medications. At the beginning of the open clinical trials, the patients had already been receiving clozapine treatment for 24 ± 15 months. Assessment of the biochemical and psychopathological measures was performed on six occasions at consecutive 6-week intervals during maintenance treatment with clozapine or conventional neuroleptics. Blood levels of serotonin, 3-methoxy-4-hydroxy-phenylglycol (MHPG), norepinephrine, and epinephrine were significantly higher in clozapine-treated patients than in conventionally treated patients. During long-term treatment, higher serotonin levels were associated with significantly fewer negative symptoms of schizophrenia, whereas higher MHPG levels were correlated with less depression. The short-term effects of clozapine were assessed in a second and independent study sample. After failing on conventional neuroleptics in clinical trials lasting a mean of 1.6 years, 15 inpatients (aged 11–20 years) received clozapine. Weekly ratings of psychopathological symptoms using standard rating scales were performed in parallel to blood samplings for measurements of biogenic amines and serum levels of clozapine. These measures were obtained for 6 weeks during conventional neuroleptic treatment and for 6 weeks during the open-label clozapine trial. Serum levels of serotonin and plasma norepinephrine levels were significantly higher during treatment with clozapine than during pretreatment with typical neuroleptics. A comparison of plasma epinephrine levels in responders (n=7) and nonresponders (n=8) to clozapine revealed that response to clozapine can be predicted by epinephrine levels prior to initiation of treatment with clozapine (responders ranging from 32.2 to 90.3 pg/ml; nonresponders ranging from 92.5 to 473.5 pg/ml). Additionally, subjects who responded to clozapine showed increased mean plasma concentrations of MHPG and epinephrine during treatment with this drug in comparison to the levels measured during pretreatment with typical neuroleptic medication. Nonresponders to clozapine failed to show this increase. Finally, in responders to clozapine a negative linear relationship between negative symptoms of schizophrenia and the concentrations of plasma norepinephrine and serum serotonin were observed. In conclusion, our results demonstrate that plasma epinephrine levels prior to initiation of clozapine therapy predict response to this atypical neuroleptic. Our findings derived from short-term and maintenance treatment with clozapine suggest involvement of norepinephrine, epinephrine and serotonin in the therapeutic actions of the atypical neuroleptic clozapine.     

Diabetes mellitus among outpatients receiving clozapine: prevalence and clinical-demographic correlates

BACKGROUND: Treatment with antipsychotic drugs has been associated with increased risk for developing diabetes mellitus. Recent consensus statements suggest that clozapine may pose an especially high risk. The purpose of this study is to examine the prevalence and clinical-demographic correlates of diabetes among outpatients with DSM-IV-diagnosed schizophrenia or schizoaffective disorder receiving clozapine. METHOD: One hundred one outpatients receiving clozapine at the University of Rochester Department of Psychiatry, Rochester, N.Y., were evaluated between September 2002 and September 2003. Demographic data were collected from medical records, and body mass index (BMI) and body fat measurements were conducted. Diagnosis of diabetes was established through review of medical records and fasting blood glucose testing. Associations between clinical and demographic variables and diabetes were examined using t tests, Fisher exact tests, and logistic regression. RESULTS: Mean (SD) age of patients was 40.4 (9.5) years, and 79% were white. Mean (SD) dose and duration of clozapine treatment were 426 (164) mg/day and 5.7 (3.6) years, respectively. Point prevalence of diabetes was 25.7%. Mean (SD) BMI was 32.6 (8.0) kg/m(2), and mean (SD) body fat was 34.0% (11.0%). Logistic regression revealed significant associations between diabetes and nonwhite race/ethnicity and family history of diabetes (p = .02 and .002, respectively). No significant associations were found between diabetes prevalence and BMI or body fat. CONCLUSION: Patients receiving clozapine are at substantial risk for developing diabetes, although the level of risk relative to other antipsychotic medications has not been fully determined. Clinicians should monitor all severely mentally ill patients receiving antipsychotic drugs for diabetes, with closer monitoring of patients with established demographic risk factors.     

Serum Free Fatty Acids and Glucose Metabolism, Insulin Resistance in Schizophrenia with Chronic Antipsychotics

BACKGROUND: Weight gain and type 2 diabetes mellitus (DM) are often linked to antipsychotics treatment. The aim of the study is to investigate serum free fatty acids (FFA) levels in schizophrenic patients who received long-term antipsychotics treatment, and to explore the associations between serum FFA and fasting blood glucose, and insulin resistance. METHODS: 308 inpatients with schizophrenia who met with the criteria of DSM-IV were recruited into this study, and were divided into four groups: control subjects, single obesity, impaired glucose tolerance (IGT) and type 2 DM according to different body mass index, fasting blood glucose level and 2-hour postprandial blood glucose. Serum FFA was measured with colorimetry. Serum insulin and leptin were measured with radioimmunoassay respectively. RESULTS: There was a significant elevation in serum FFA levels in schizophrenic patients who received long-term antipsychotics treatment, especially in single obesity, IGT, and DM groups. The elevated serum FFA was remarkably positive correlated with fasting blood glucose and insulin resistance. CONCLUSIONS: The study suggested the elevated serum FFA in schizophrenic patients with long-term antipsychotics treatment affected the blood glucose metabolism, may have played an important role in insulin resistance and type 2 DM, and was also an important trait of metabolic syndromes.     

氯丙咪嗪与舒必利辅助治疗精神分裂症阴性症状的对照研究

目的： 比较氯丙咪嗪、舒必利辅助治疗精神分裂症阴性症状的效果。　方法： 使用氯丙咪嗪、舒必利分别作为氯氮平的辅助用药与单用氯氮平对８８ 例以阴性症状为主的精神分裂症病人进行对照研究; 以简明精神病评定量表、阴性症状量表和副反应量表进行评定。　结果： 合并氯丙咪嗪组、舒必利组及单用氯氮平组对阴性症状的治疗显效率分别为６９％ 、３１％ 、１３３３％ 。　结论： 氯氮平合并氯丙咪嗪治疗能有效地改善精神分裂症的阴性症状。     

二甲双胍对住院精神分裂症伴糖耐量减低患者干预的3年随访

目的:观察二甲双胍干预对糖耐量减低(IGT)的住院精神分裂症患者糖尿病发病率的作用. 方法:对符合《中国2型糖尿病防治指南2007》诊断标准的78例IGT住院精神分裂症患者,随机分为对照组、饮食+运动组和二甲双胍组,每组26例,随访观察3年. 结果:初访时3组基线资料无统计学差异.3年末,对照组糖尿病发生率为73.1％( 19/26);饮食加运动组为45.5％ (10/22);二甲双胍组为16.7％ (4/24),组间存在统计学差异(X2=15.998,P=0.000),二甲双胍组与对照组比较,存在统计学差异(X2=15.987,P=0.000);二甲双胍组与饮食加运动组比较,存在统计学差异(X2=4.493,P=0.034);饮食加运动组与对照组比较,无统计学差异(X2=3.802,P=0.051).二甲双胍组3年末糖化血红蛋白( GHbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)与饮食+运动组和对照组比较均存在统计学差异(P＜0.05). 结论:二甲双胍与行为干预单一或联合治疗均对减轻精神分裂症患者IGT发展到糖尿病(DM)可能有一定效果,二甲双胍联合行为干预的疗效更好.