氯氮平快速滴定的风险和益处。

IF 9 Q1 PSYCHIATRY Mental Illness Pub Date : 2016-05-18 DOI:10.4081/mi.2016.6457
Jeannie D Lochhead, Michele A Nelson, Alan L Schneider
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引用次数: 11

摘要

氯氮平通常被认为是治疗精神分裂症的黄金标准。临床指南建议在2周内逐渐滴药,以降低癫痫发作、低血压、粒细胞缺乏症和心肌炎等不良事件的风险。缓慢的滴定常常延迟治疗反应的时间。这就提出了一个问题,在某些患者中,使用更快速的氯氮平滴定是否安全。以下病例说明了与使用多种抗精神病药物和快速氯氮平滴定相关的潜在风险。我们提出的情况下,一个年轻的男子精神分裂症谁发展危及生命的神经安定恶性综合征(NMS)在快速氯氮平滴定和治疗与多种抗精神病药物。我们在文献中未发现另一例与氯氮平快速滴定相关的NMS病例。本病例旨在敦促临床医生认真评估氯氮平快速滴定的风险和益处,并鼓励研究人员进一步评估氯氮平快速滴定的安全性。快速氯氮平滴定具有降低与长期住院相关的医疗保健费用和减少与不受控制的精神病症状相关的情绪痛苦的意义。氯氮平被认为是目前可用的最有效的抗精神病药物,因此应致力于制定最安全、最有效地使用氯氮平的策略,以鼓励其用于治疗耐药性精神分裂症。
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Risks and Benefits of Rapid Clozapine Titration.

Clozapine is often considered the gold standard for the treatment of schizophrenia. Clinical guidelines suggest a gradual titration over 2 weeks to reduce the risks of adverse events such as seizures, hypotension, agranulocytosis, and myocarditis. The slow titration often delays time to therapeutic response. This raises the question of whether, in some patients, it may be safe to use a more rapid clozapine titration. The following case illustrates the potential risks associated with the use of multiple antipsychotics and rapid clozapine titration. We present the case of a young man with schizophrenia who developed life threatening neuroleptic malignant syndrome (NMS) during rapid clozapine titration and treatment with multiple antipsychotics. We were unable to find another case in the literature of NMS associated with rapid clozapine titration. This case is meant to urge clinicians to carefully evaluate the risks and benefits of rapid clozapine titration, and to encourage researchers to further evaluate the safety of rapid clozapine titration. Rapid clozapine titration has implications for decreasing health care costs associated with prolonged hospitalizations, and decreasing the emotional suffering associated with uncontrolled symptoms of psychosis. Clozapine is considered the most effective antipsychotic available thus efforts should focus on developing strategies that would allow for safest and most efficient use of clozapine to encourage its utilization for treatment resistance schizophrenia.

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来源期刊
Mental Illness
Mental Illness PSYCHIATRY-
CiteScore
1.10
自引率
0.00%
发文量
3
审稿时长
10 weeks
期刊介绍:
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