精神疾病患者猝死前心电图分析

目的：探讨精神疾病患者猝死前心电图特征及其相关影响因素。方法：将临床诊断为心脏性猝死的49例患者作为猝死组；随机抽出同期住院的60例患者作为对照组。比较两组患者心电图特征，人口学资料以及临床特征。结果：猝死组心电图异常发生率显著高于对照组（P〈0．05），主要表现为窦性心动过速、室性期前收缩、QT间期延长、T波改变、ST段低平、U波或TU融合波、左束支传导阻滞（LBBB）。猝死组氯氮平使用率显著高于对照组（P〈0．05）。两组使用氯氮平者心电图异常率明显高于未使用氯氮平者（P〈0．05或P〈0．01）。猝死组高龄，兴奋状态，低血钾，肌酸激酶升高，心脑血管疾病的发生率均显著高于对照组（P均〈0．05）。结论：精神疾病患者猝死前大多心电图异常，多呈非特异性改变。高龄、使用氯氮平以及某些临床征象可能成为患者猝死的危险因素。     

抗精神病药引起心电图异常临床分析

目的：探讨抗精神病药对心脏的影响。方法：自编调查表，回顾性分析我院426例服用抗精神病药的住院患者的心电图变化及影响因素。结果：426例患者中165例出现心电图异常，发生率38．7％；以ST—T异常及心率异常为多见。结论：在服用抗精神病药治疗过程中，心电图监测非常必要。     

氯氮平治疗与糖耐量异常的关系探讨

目的 探讨住院病人服用氯氮平与糖耐量异常(IGT)的相关性。方法 选择精神分裂症病人294例,按所服用药物分为氯氮平组与对照组,比较两组病人糖耐量异常发生率差异及氯氮平组中糖耐量异常患者与服药时间的相关性。结果 氯氮平组中糖耐量异常发生率19.1％,对照组糖耐量异常发生率7.2％,两者存在显著性差异(P<0.005)。氯氮平组中的糖耐量异常患者,其服药时间明显长于非糖耐量异常患者,两者经t检验比较,t=3.14(P<0.01),有显著性差异。结论 氯氮平与糖耐量异常的发生存在一定的相关;服用氯氮平时间越长,糖耐量异常(IGT)发生的可能性增高,最终可能导致2型糖尿病的发生。     

长期服用阿立哌唑和氯氮平对心脏功能的影响

目的比较分析阿立哌唑和氯氮平长期服用对心脏的安全性。方法随机选取精神分裂症患者86例,根据治疗药物的不同分A组和L组各43例,其中A组服用阿立哌唑治疗,L组服用氯氮平治疗,在治疗后每隔1个月检查患者的心脏功能和心电图检查。结果 2组患者精神分裂症状指标及心功能评分差异无统计学意义,在治疗过程中,A组和L组患者心电图及心功能检查结果均出现对心脏的不良反应,心电图异常及心脏功能减退以L组更明显。结论 A组患者的心脏功能及心电图检查结果显示的不良反应要明显低于L组,阿立哌唑安全性更高。     

住院精神疾病患者糖耐量研究

目的：研究住院精神疾病患者服用抗精神病药对糖耐量的影响。方法：对我院住院治疗的精神疾病患者在服药前后测定口服葡萄糖糖耐量试验(OGTT)，并分析影响糖代谢异常的相关因素。结果：在112例住院患者中，发现有糖代谢异常者26例，发生率为23．2％以服用氯氮平发生率为最高。结论：服用抗精神病药可影响患者血糖代谢，应引起重视。     

心得安对氯氮平所致心电图T波异常的疗效

心得安对氯氮平所致心电图Ｔ波异常的疗效俞柏润朱毅平付娟据报告氯氮平引起心电图Ｔ波异常的发生率可高达８０．８％（郑瞻培，等．中国神经精神疾病杂志，１９８５，３：１８２），我们以心得安治疗有一定疗效。所观察的系１９９３年１月～１９９５年６月住院男性患者。...     

氯氮平引起糖耐量异常的相关因素分析

目的　探讨氯氮平治疗引起糖耐量异常的相关因素。方法　将空腹血糖 7 0mmol/L 11.1mmol/L作为诊断糖耐量异常 (IGT)的标准 ,对 130例服用氯氮平的患者进行调查 ,对有关资料进行分析。结果　130例服用氯氮平的患者中有 18例出现糖耐量异常 ,发生率为 13 8%。有与无糖耐量异常两组之间年龄、家族史和体重指数差异有显著性 ,而性别、血脂、服药剂量和时间等差异无显著性。结论　服用氯氮平的患者糖耐量异常的发生率远高于一般人群 ,年龄较大、有糖尿病家族史及肥胖者发生机率更大     

利培酮与氯氮平对心电图影响的对照研究

目的　研究利培酮与氯氮平对心电图影响的差异。方法　使用ECG— 90 2 0机检查 6 0例服用利培酮和 30例服用氯氮平的精神分裂症患者的心电图变化 ,并对结果进行分析。结果　服用利培酮后心电图变化异常率为 11 7% ,服用氯氮平后心电图变化异常率为 4 3 3% ,二者有显著差异 (P <0 .0 1)。结论　提示利培酮对心脏的毒性副作用明显低于氯氮平。     

利培酮、氯氮平对精神分裂症患者心电图的影响

目的研究利培酮与氯氮平引起心电图改变对心脏的影响。方法215例精神分裂症患者在服药前、服药后2、4、8周分别作心电图检查。结果服用利培酮、氯氮平后均可引起心电图改变，其中窭性心动过速、心肌缺血均以氯氮平组显著较多。心电图改变与服药时间、药物剂量有关。结论利培酮引起心电图改变显著少于氟氮平，安全性高。不良反应轻微。     

氯氮平治疗精神分裂症脑电图改变分析

为了解精神分裂症病人服用氯氮平对脑电图的影响,对34例服用氯氮平治疗的精神分裂症病人进行脑电图描记。结果发现34例中轻度异常17例,中度异常9例,高度异常2例,异常脑电图的发生率为82．3％。主要脑电图改变是α节律不规则甚至消失,同时出现明显慢波化,电位增高,有阵发性θ波、δ波出现,均呈弥漫性改变,提示这种改变似与疗效有关。     

Electrocardiographic abnormalities in patients treated with clozapine

BACKGROUND: Cardiovascular side effects of clozapine are not uncommon, but few systematic studies of these effects have been performed. In this study, we reviewed data on the electrocardiographic (ECG) abnormalities in patients treated with clozapine. METHOD: Sixty-one patients treated with clozapine were selected from the Seoul National University Hospital Treatment-Resistant Schizophrenia Clinic. A retrospective chart review was conducted to identify ECG abnormalities and cardiovascular side effects. RESULTS: The prevalence of ECG abnormalities in patients who had been using antipsychotics other than clozapine was 13.6% at baseline, which increased significantly to 31.1% after commencement of clozapine treatment. Among the 53 patients without baseline ECG abnormalities, 13 showed new-onset ECG abnormalities after using clozapine. Normal ECG under previous antipsychotic medication reduced the risk of new-onset ECG abnormalities, whereas increased age was found to increase the risk. The occurrence of orthostatic hypotension or tachycardia was not related to the development of ECG abnormalities. Most of the newly developed abnormalities had little clinical significance, and they tended to occur during the initial phase of treatment. In 10 patients, ECGs normalized despite the continued use of clozapine. Clozapine increased corrected QT interval (QTc) in a dose-dependent fashion; however, the clinical significance of this observation is uncertain. Pathologic prolongation of QTc was found to be rare. CONCLUSION: Although a substantial portion of patients treated with clozapine developed ECG abnormalities, most of the abnormalities were benign and did not hinder further treatment.     

利培酮对心电图的影响

目的研究利培酮引起心电图改变的特征及其与服药时间、剂量之间的关系,并与氯氮平引起的心电图改变作比较.方法对符合CCMD-2-R诊断标准的精神分裂症、分裂样精神障碍患者,在服药前、服药后4周、8周分别作心电图检查,记录服药剂量与心电图改变的情况,并在利培酮组与氯氮平组之间作显著性检验.结果利培酮引起的心电图改变主要为窦性心动过速、T波变化,其程度及发生率均低于氯氮平,一般不影响治疗.并且与服药天数、剂量大小有一定的关系.结论利培酮可引起心电图的改变,其程度及发生率低于氯氮平.     

Addition of low-dose fluvoxamine to low-dose clozapine monotherapy in schizophrenia: drug monitoring and tolerability data from a prospective clinical trial.

Combining fluvoxamine and clozapine may be a strategy to improve therapeutic effects on negative symptoms in schizophrenic patients. Fluvoxamine, however, markedly inhibits the metabolism of clozapine, and hazardous side effects may result. This study prospectively investigated the safety and tolerability of an add-on therapy with fluvoxamine to a clozapine monotherapy in schizophrenic patients. Sixteen schizophrenic patients received 50 mg fluvoxamine as a comedication after having reached steady-state conditions under clozapine monotherapy. Patients were monitored for subjective adverse events, laboratory parameters, EEG and ECG recordings, orthostatic hypotension and their psychopathology. Concomitantly, serum concentrations of clozapine and metabolites were measured during monotherapy and after addition of fluvoxamine. In all patients, the serum concentrations of clozapine and metabolites were markedly increased (average: 2-3 fold, up to 5 fold for clozapine) after addition of fluvoxamine. Side effects remained almost unchanged in frequency and severity in spite of the pharmacokinetic interactions. ECG or laboratory parameters and orthostatic tests were similar under monotherapy and comedication. Minimal increases of EEG abnormalities were observed, but they were not associated with clinical impairment. Epileptic activities were always absent. The psychopathology improved which continued after start of the comedication. Though the addition of fluvoxamine to clozapine medication was well tolerated and critical side effects were absent, the combined treatment should be controlled by drug monitoring, as serum concentrations of clozapine increased to unpredictably high levels. Further studies have to find out if the combined treatment could be advantageous to clozapine monotherapy.     

奥氮平和氯氮平治疗精神分裂症老年患者的对照研究

目的：对比奥氮平与氯氮平治疗精神分裂症老年患者的疗效和安全性。方法：对64例精神分裂症老年患者分别给予奥氮平、氯氮平治疗，其中奥氮平组30例，氯氮平组34例，疗程8周。以阳性症状和阴性症状量表(PANSS)、临床疗效总评量表(CGI)、简明精神病评定量表(BPRS)评定临床疗效。以副反应量表(TESS)和实验室监测评价安全性。结果：治疗结束时，两组PANSS和BPRS总分较治疗前显著降低，组间差异无显著性。两组间从治疗第1周起各时点PANSS减分率差异有显著性。临床有效率：奥氮平组76．7％，氯氮平组64．7％，两组相仿。奥氮平组不良反应较氯氮平组少，常见不良反应为胆碱能作用、嗜睡、体重增加和一过性肝酶升高等。结论：奥氮平治疗精神分裂症的疗效与氯氮平相似，某些不良反应较氯氮平轻而少；是一种安全有效、服用方便的新型抗精神病药。     

Clozapine for the treatment of aggressiveness and agitation in advanced dementia

Background

Distressing behavioural symptoms, particularly agitation and aggressiveness, remain a difficult problem in everyday clinical practice in the treatment of multimorbid patients with dementia. Clozapine may be an effective therapeutic alternative in this context.

Methods

In a retrospective study, patients who had a diagnosis of dementia and had been treated in a specialized geriatric psychiatry unit with clozapine between August 2018 and February 2022 were included, and medical records were systematically reviewed. The Clinical Global Impressions Scale was used to assess improvement, and the Pittsburgh Agitation Scale for symptom reduction. In addition, side effects and clinical features were documented in detail.

Results

A total of 31 patients (median age 82 years) were identified with a mean clozapine dose of 47.2 (SD 35.6) mg. A total of 13 patients tolerated clozapine very well, 10 showed tolerable side effects, and in 10 patients side effects were the reason for stopping clozapine. Behavioural symptoms improved significantly, as indicated by the assessment scores.

Conclusions

In summary, clozapine was effective and well tolerated in 23 patients, suggesting that low-dose clozapine may help to alleviate the suffering of difficult-to-treat multimorbid patients with advanced dementia and their caregivers. However, particular attention should be paid to adverse drug reactions, especially in patients with cardiovascular and pulmonary impairment.     

维思通与氯氮平治疗精神分裂症对照分析

用维思通治疗精神分裂症３３例，与用氯氮平治疗的３１例进行对照研究。两组以阴性症状量表（ＳＡＮＳ），阳性症状量表（ＳＡＰＳ），简明精神病量表（ＢＰＲＳ）和副反应量表进行盲式评分。结果显示：虽然氯氮平对治疗阴性阳性症状均有较好疗效，但维思通更明显优于氯氮平，且副作用较小。本文对维思通的疗效，临床应用，副作用，作用机理进行了讨论。     

The effects of novel antipsychotics on glucose and lipid levels

BACKGROUND: The novel antipsychotics are extensively used based on their favorable extrapyramidal side effect profiles. However, accumulating evidence suggests that these agents, particularly clozapine and olanzapine, have serious side effects of their own, including weight gain and elevated glucose and triglyceride levels. The goal of this study is to compare the effects of novel antipsychotics clozapine, olanzapine, risperidone, and quetiapine and typical antipsychotics haloperidol and fluphenazine on glucose and lipid levels. METHOD: The charts of 590 patients were retrospectively reviewed. Of those, 215 patients had adequate laboratory data for inclusion. Glucose and lipid level data from 2 1/2 years before and after initiation of the target antipsychotic were included. Covariates, including patients' age, the duration of antipsychotic treatment, other medications that may affect glucose or lipid levels, and the initial laboratory values, were controlled for in the analyses. RESULTS: Glucose levels were increased from baseline for patients treated with clozapine, olanzapine, and haloperidol. There were statistically and clinically significant differences among the medications' effects on lipid profiles (p < .05). Those receiving clozapine and olanzapine demonstrated statistically significant increases in triglyceride levels compared with the other groups. Over one third of patients treated with any of the novel antipsychotics had clinically meaningful triglyceride elevations. CONCLUSION: It has been shown that novel antipsychotics are associated with weight gain. This risk factor along with others, such as elevated glucose and triglyceride levels, compounds the risk for coronary artery disease. Routine monitoring of glucose and lipid levels during treatment with novel antipsychotics should be advocated.     

The European experience with use of clozapine

The efficacy and adverse effects of clozapine for patients who cannot be treated with conventional neuroleptics were evaluated by means of a retrospective chart review. The review showed that 85 percent of 503 inpatients experienced slight to nearly complete reduction in symptoms. Adverse effects occurred in 59 percent of patients, although only 7 percent had side effects severe enough to warrant discontinuation of the drug. Data for 70 outpatients treated with clozapine showed that the rate of rehospitalization was significantly lower than before treatment with the drug. These findings agree with those of other European studies and suggest that when hematological and other variables are carefully controlled, the benefits of clozapine therapy outweigh the risks.