抗精神病药致麻痹性肠梗阻12例分析

目的：探讨住院精神疾病患者发生麻痹性肠梗阻的原因及影响因素。方法：对12例发生麻痹性肠梗阻患者进行回顾分析。结果：发生肠梗阻时有9例服氯氮平,2例单一使用奋乃静,1例单一使用舒必利。有10例在发生肠梗阻前有较长时间的饮食不佳和低血钾。结论：抗精神病药可引起麻痹性肠梗阻,饮食不佳和低血钾也为其重要影响因素。     

16例住院精神病人发生麻痹性肠梗阻的临床资料分析及护理对策

目的探讨住院精神病患者麻痹性肠梗阻的发生原因及护理对策。方法对16例发生麻痹性肠梗阻患者的临床资料进行分析。结果单一用药10例,其中氯氮平6例,利培酮,喹硫平,帕罗西汀,多虑平各1例,联合用药6例,饮食不当2例,低血钾4例。结论抗精神病药、低血钾、饮食不当等均可引致麻痹性肠梗阻发生。     

氯氮平致麻痹性肠梗阻16例分析

目的 调查分析住院精神病患者服用氯氮平引起麻痹性肠梗阻的原因。方法 采用自拟患者一般情况调查表，对16例麻痹性肠梗阻患者逐一分析。结果发现首次住院发生麻痹性肠梗阻的8例(50.00％)，入院服用氯氮平3月内并发麻痹性肠梗阻的12例(75.00％)，50岁以下的精神病患者14例(87.5%)，麻痹性肠梗阻患者占服氯氮平总数的0．11％。结论 麻痹性肠梗阻的发生与精神病患者对氯氮平的敏感性关系密切。     

抗精神病药致肠梗阻53例临床分析

目的:对抗精神病药致肠梗阻的临床特点进行分析.方法:对53例精神疾病患者在药物治疗过程中合并肠梗阻的临床表现、腹部X线检查及预后进行比较.结果:53例患者中,以40岁以上、服用抗精神病药5年以上及服用氯氮平(45.2%)后发生肠梗阻较为多见;临床表现均有渐进式腹胀、肠鸣音减弱或肠鸣音消失;腹部X线检查均可见肠管扩张及液平面;经治疗后49例痊愈,4例死亡.结论:各类抗精神病药均可引起肠梗阻,腹部X线检查有助于早期确诊.     

第二代抗精神病药对糖、脂代谢影响研究

目的：探讨2种第二代抗精神病药对糖、脂代谢的影响。方法：对精神分裂症住院患者单独应用氯氮平或利培酮治疗，监测其血糖血脂，并进行分析。结果：氯氮平引起糖代谢异常及三酰甘油升高多于利培酮；与糖代谢异常相关因素有抗精神病药种类、血脂浓度、糖尿病家族史。结论：对于有糖尿病阳性家族史、高血脂的患者，应避免选用氯氮平治疗，而利培酮可能较好。     

住院精神疾病患者血糖水平调查

目的：了解抗精神病药物对精神疾病患者血糖的影响。方法：检测全院所有住院病人的空腹血糖；对血糖浓度超标者，结合年龄、性别、体重、病程、既往使用精神药物等情况，进行相关研究。结果：340例住院患者中，血糖高于正常者65例，服用抗精神病药物后血糖升高者45例，大多数患者既往或正在使用氯氮平治疗，平均体重大于其他患者，41岁以上者居多，有较长的精神疾病史。结论：长期使用抗精神病药可能会导致高血糖，尤以氯氮平为甚。年龄、病程、体重可能与高血糖相关。     

住院精神分裂症患者抗精神病药联合治疗的影响因素分析

目的:探讨住院精神分裂症患者抗精神病药联合治疗的影响因素。方法:回顾性分析连续入组住院的801例精神分裂症患者的社会人口学资料、临床疾病相关资料,比较接受单一抗精神病药治疗的患者和接受抗精神病药联合治疗的患者在出院日处方信息资料上的差异,并进行回归分析。结果:364例(45.4%)患者接受抗精神病药联合治疗,其中284例(78.0%)联用氯氮平或奥氮平。多因素Logistic回归分析显示,患者的起病年龄、住院次数、住院天数及有无联用氯氮平或奥氮平治疗进入方程(P0.05),回归模型对患者接受单一抗精神病药治疗或抗精神病药联合治疗具有23.2%的解释度(Nagelkerke R~2=0.232)。结论:精神分裂症患者起病年龄小、住院次数多、住院时间长以及更有可能联用氯氮平或奥氮平是抗精神病药联合治疗的影响因素。     

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。     

精神分裂症患者伴发糖尿病的相关因素分析

目的 为了解住院精神分裂症患者伴发糖尿病的相关因素。方法 回顾性调查住院精神分裂症患者发生糖尿病与精神药物、体重、血糖及血脂等的相关性。结果 在1472例精神分裂症患者中伴发糖尿病者共162例(11．0％)，其发生与患者的年龄、病程、体重、甘油三酯、胆固醇及服用抗精神病药有相关性，而与性别无关。结论 患者年龄越大、病程越长糖尿病的发生率越高，长期使用抗精神病药可能会导致糖尿病，尤以氯氮平为甚。     

与抗精神病药有关的住院患者死亡分析

为探讨住院精神病患者的死因，我们调查了与抗精神病药有关的住院死亡病例，报道于下。１．一般资料：调查我院１９８５年１月１日至１９９６年１２月３１日死亡的２１２例住院精神病患者的病历档案，其中与抗精神病药有关者７２例，占１２年住院总例数的０．４０％（７２...     

Effects of clozapine and typical antipsychotic drugs on plasma 5-HT turnover and impulsivity in patients with schizophrenia: a cross-sectional study

OBJECTIVE: To compare the efficacy of clozapine with typical antipsychotic drugs in controlling impulsivity and to explore the possible correlation of impulsivity with plasma 5-hydroxytryptamine (5-HT) levels, plasma 5-hydroxyindoleacetic acid (5-HIAA) levels and plasma 5-HT turnover. DESIGN: Prospective, cross-sectional study open to medication and blinded to biochemical analyses. PARTICIPANTS: Healthy control subjects (n = 24) and 46 inpatients and outpatients meeting the DSM-IV criteria for schizophrenia; 20 were being treated with clozapine and 26 were taking typical antipsychotic drugs. INTERVENTIONS: All psychotropic drugs other than clozapine or typical antipsychotic drugs were discontinued for at least 5 days and subjects fasted overnight before they were assessed. OUTCOME MEASURES: Coccaro Impulsivity Scale scores, plasma 5-HT levels, 5-HIAA levels and 5-HT turnover. RESULTS: Patients treated with clozapine and those treated with typical antipsychotics had significantly higher impulsivity scores than the control group, and the mean impulsivity score of the typical antipsychotic group was significantly higher than that of patients treated with clozapine. The mean concentration of 5-HT of the typical antipsychotic group was significantly lower than that of the control group and patients treated with clozapine; however, mean plasma levels of 5-HIAA were significantly higher for the clozapine group than the other 2 groups. 5-HT turnover was significantly higher for the 2 drug-treatment groups than for the control group. CONCLUSIONS: These results suggest that treatment with clozapine should be considered for patients with schizophrenia who are impulsive and aggressive.     

Tolerability and therapeutic effect of clozapine. A retrospective investigation of 216 patients treated with clozapine for up to 12 years

Two hundred and sixteen psychiatric patients (183 men and 33 women) hospitalized in Sct. Hans Hospital were treated with clozapine between 1971-1983. All had been treated previously with one or more neuroleptic(s) and had either failed to respond adequately, or their response was limited by side effects. Eighty-five patients were treated exclusively with clozapine, while the remaining 131 received additional medication, mainly other neuroleptic drugs. The mean clozapine dosage was 317 mg/day (range 50-1200), and the mean duration of treatment was 23/4 years (range 1/12-12). The tolerability to clozapine was determined by an evaluation of haematological changes, pronounced side effects and mortality. One patient treated with clozapine (8 months) and nitrofurantoin (8 days) developed a reversible granulocytopenia. One patient (treated with a combination of drugs) had clinically insignificant depression of the leucocytes and three of segmented granulocytes. Seven had a reduction in thrombocytes. Two patients developed cardiac insufficiency, and four epileptic seizures. None of the patients treated exclusively with clozapine developed neurological side effects. A global estimation of therapeutic effect revealed that clozapine alone or in combination with other neuroleptic drugs was significantly better than previous antipsychotic therapy, although 47-63% of the patients showed no change. It is concluded that clozapine is a potent antipsychotic drug offering particular advantages in the treatment of schizophrenic patients with a pronounced symptomatology and tendency towards developing extrapyramidal side effects. Caution is advised in patients with cardiac insufficiency and epilepsy. There appears to be a slight risk of granulocytopenia, and therefore the present monitoring of WBC should continue in order to prevent this reaction and to obtain more complete information regarding risk of granulocytopenia.     

Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine. Relation to extrapyramidal side effects.

Positron emission tomography and selective radioligands were used to determine D1 and D2 dopamine receptor occupancy induced by neuroleptics in the basal ganglia of drug-treated schizophrenic patients. In 22 patients treated with conventional dosages of classical neuroleptics, the D2 occupancy was 70% to 89%. Patients with acute extrapyramidal syndromes had a higher D2 occupancy than those without side effects. This finding indicates that neuroleptic-induced extrapyramidal syndromes are related to the degree of central D2 occupancy induced in the basal ganglia. In five patients treated with clozapine, the prototype atypical antipsychotic drug, a lower D2 occupancy of 38% to 63% was found. This finding demonstrates that clozapine is also "atypical" with respect to the central D2 occupancy in patients. During treatment with clozapine, there is a low frequency of extrapyramidal syndromes, which accordingly may reflect the comparatively low D2 occupancy induced by clinical doses of clozapine. Classical neuroleptics, like haloperidol or sulpiride, did not cause any evident D1 occupancy, but the thioxanthene flupentixol induced a 36% to 44% occupancy. In four patients treated with clozapine, the D1 occupancy was 38% to 52%. The D1 occupancy induced by clozapine and flupentixol may contribute to the antipsychotic effect of these drugs.     

Is clozapine antisuicidal?

Suicide accounts for approximately 10% of patient deaths in schizophrenia. The atypical antipsychotic clozapine (Clozaril), successful in treatment-resistant patients with schizophrenia, may have an additional antisuicidal effect. Numerous published reports, including the collaborative International Suicide Prevention Trial, have compared mortality rates between clozapine recipients and patients receiving other forms of antipsychotic treatment and observed a significant reduction in patient risk for suicide with clozapine therapy. Preliminary reports indicate improvements in suicidality in schizophrenia patients treated with other modern atypical antipsychotics, for example olanzapine [Zyprexa], risperidone [Risperdal] and sertindole [Serdolect], but further investigation is required to clarify their role as antisuicidal drugs. It has been estimated that 53 suicides in treatment-resistant patients could have been prevented by clozapine, but the number of lives saved may be significantly higher if clozapine therapy was extended to treatment responders at a high risk for suicide.     

Clozapine and obsessions in patients with recent-onset schizophrenia and other psychotic disorders.

BACKGROUND: The increase or emergence of obsessions was compared in young patients with recent-onset schizophrenia or other psychotic disorders taking clozapine and other antipsychotic drugs. METHOD: We conducted a retrospective cohort study. Subjects were 121 consecutively admitted patients diagnosed with DSM-III-R schizophrenia, schizoaffective disorder, schizophreniform disorder, or psychotic disorder not otherwise specified. Obsessions were diagnosed according to DSM-IV criteria. RESULTS: More clozapine-treated subjects (20.6%) than subjects treated with other antipsychotic drugs (1.3%) experienced an emergence or increase of obsessions (p<.01). CONCLUSION: Use of clozapine is associated with the emergence or increase of obsessions in early-phase schizophrenia.     

痴呆的行为和精神症状的药物治疗调查

目的：了解抗精神病药治疗痴呆的行为和精神症状（BPSD）的情况。方法：调查443例伴有明显的行为和精神症状、用抗精神病药治疗其行为和精神症状有效的阿尔茨海默病和血管性痴呆患者。结果：常用于治疗BPSD的抗精神病药有奋乃静、利培酮、氟哌啶醇、氯丙嗪、氯氮平、硫利达嗪、舒必利等,其起始剂量与有效剂量均较小,大多单一用药。用药剂量与年龄呈负相关。主要不良反应是锥体外系反应、便秘或排尿困难、嗜睡或步态不稳、吞咽困难等。抗精神病药不良反应发生率为16．0％,典型抗精神病药发生率（18．4％）显著高于非典型抗精神病药（9．6％）。结论：多种抗精神病药治疗BPSD均有效,治疗剂量低。非典型抗精神病药的安全性优于典型抗精神病药。     

Neurocognitive effects of clozapine,olanzapine, risperidone,and haloperidol in patients with chronic schizophrenia or schizoaffective disorder

OBJECTIVE: Newer antipsychotic drugs have shown promise in ameliorating neurocognitive deficits in patients with schizophrenia, but few studies have compared newer antipsychotic drugs with both clozapine and conventional agents, particularly in patients who have had suboptimal response to prior treatments. METHOD: The authors examined the effects of clozapine, olanzapine, risperidone, and haloperidol on 16 measures of neurocognitive functioning in a double-blind, 14-week trial involving 101 patients. A global score was computed along with scores in four neurocognitive domains: memory, attention, motor function, and general executive and perceptual organization. RESULTS: Global neurocognitive function improved with olanzapine and risperidone treatment, and these improvements were superior to those seen with haloperidol. Patients treated with olanzapine exhibited improvement in the general and attention domains but not more than that observed with other treatments. Patients treated with risperidone exhibited improvement in memory that was superior to that of both clozapine and haloperidol. Clozapine yielded improvement in motor function but not more than in other groups. Average effect sizes for change were in the small to medium range. More than half of the patients treated with olanzapine and risperidone experienced "clinically significant" improvement (changes in score of at least one-half standard deviation relative to baseline). These findings did not appear to be mediated by changes in symptoms, side effects, or blood levels of medications. CONCLUSIONS: Patients with a history of suboptimal response to conventional treatments may show cognitive benefits from newer antipsychotic drugs, and there may be differences between atypical antipsychotic drugs in their patterns of cognitive effects.     

抗精神病药对精神分裂症患者体重的影响

目的 为了探讨抗精神病药对精神分裂症患者体重的影响。方法 295例服用抗精神病药的精神分裂症患者进行了临床调查。结果 67．12％患者出现体重增加；体重增加从多到少的药物依次是氯氮平、奥氮平、氯氮平合并利培酮、氯丙嗪、利培酮、氯氮平合并舒必利；氯氮平、氯丙嗪、利培酮体重增加较人组前有显著差异；女性患者、初次服抗精神病药者、合并心境稳定剂者体重增加亦明显。结论 大部分抗精神病药可导致体重增加，应在治疗前及治疗中定期进行体重监测。     

抗精神病药物对精神分裂症患者血脂、血糖和体重影响的研究

目的比较精神分裂症患者服用抗精神病药物后血脂、血糖及体重的变化,评价不同药物的安全性。方法选择109例单一应用抗精神病药物治疗满8周的精神分裂症患者,分别于第4周、第8周测量血脂(胆固醇、甘油三脂)、血糖和体重。结果服用抗精神病药物后女性、高龄患者甘油三脂增高显著,差异有统计学意义(t=-2.34,P<0.05;r=0.256,P=0.007);氯氮平对胆固醇升高影响显著高于利培酮、奎硫平、氯丙嗪、奋乃静等(P<0.05);氯氮平、氯丙嗪对甘油三脂升高影响显著高于利培酮(P<0·05);所有纳入研究的药物对血糖、体重有不同程度影响,差异无显著性(P>0.05)。结论大多数抗精神病药物可增加高血脂、肥胖的风险,选择药物应考虑性别及年龄因素。     

Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment

OBJECTIVE: When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug, it is unclear what other antipsychotic to switch to and when to use clozapine. In this study, the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness (CATIE) investigation. METHOD: Ninety-nine patients who discontinued treatment with olanzapine, quetiapine, risperidone, or ziprasidone in phase 1 or 1B of the trials, primarily because of inadequate efficacy, were randomly assigned to open-label treatment with clozapine (N=49) or blinded treatment with another newer atypical antipsychotic not previously received in the trial (olanzapine [N=19], quetiapine [N=15], or risperidone [N=16]). RESULTS: Time until treatment discontinuation for any reason was significantly longer for clozapine (median=10.5 months) than for quetiapine (median=3.3), or risperidone (median=2.8), but not for olanzapine (median=2.7). Time to discontinuation because of inadequate therapeutic effect was significantly longer for clozapine than for olanzapine, quetiapine, or risperidone. At 3-month assessments, Positive and Negative Syndrome Scale total scores had decreased more in patients treated with clozapine than in patients treated with quetiapine or risperidone but not olanzapine. One patient treated with clozapine developed agranulocytosis, and another developed eosinophilia; both required treatment discontinuation. CONCLUSIONS: For these patients with schizophrenia who prospectively failed to improve with an atypical antipsychotic, clozapine was more effective than switching to another newer atypical antipsychotic. Safety monitoring is necessary to detect and manage clozapine's serious side effects.