目的:氯氮平是一种具有复杂受体谱的强效抗精神病药物。它被保留用于治疗抗性精神分裂症。我们系统回顾了氯氮平戒断的非精神病症状的研究。
方法:CINAHL,Medline,PsycINFO,PubMed,使用关键词“氯氮平”搜索了Cochrane系统评价数据库,\'和\'撤回,\'或\'超敏反应,\'\'停止,\'\'反弹,\'或\'终止\'。包括与氯氮平戒断后的非精神病症状有关的研究。
结果:分析包括5项原始研究和63例病例报告/系列。在五项原始研究中纳入的195名患者中,约20%的患者在停用氯氮平后出现非精神病症状.在四项研究中的89名患者中,经历了27次胆碱能反弹,13表现出锥体外系症状(包括迟发性运动障碍),三个人患有紧张症。包括63份病例报告/系列,报告了72例非精神病症状患者,其中卡顿(n=30),肌张力障碍或运动障碍(n=17),胆碱能反弹(n=11),5-羟色胺综合征(n=4),躁狂症(n=3),失眠(n=3),抗精神病药恶性综合征(NMS)[n=3,其中之一同时患有紧张症和NMS],和从头强迫症状(n=2)。重新启动氯氮平似乎是最有效的治疗方法。
结论:氯氮平戒断后的非精神病症状具有重要的临床意义。临床医生应该意识到症状的可能表现,以确保早期识别和管理。需要进一步的研究来更好地表征患病率,危险因素,预后,以及每种戒断症状的最佳药物剂量。
OBJECTIVE: Clozapine is a potent antipsychotic medication with a complex receptor profile. It is reserved for treatment-resistant schizophrenia. We systematically reviewed studies of non-psychosis symptoms of clozapine withdrawal.
METHODS: CINAHL, Medline, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews were searched using the keywords \'clozapine,\' and \'withdrawal,\' or \'supersensitivity,\' \'cessation,\' \'rebound,\' or \'discontinuation\'. Studies related to non-psychosis symptoms after clozapine withdrawal were included.
RESULTS: Five original studies and 63 case reports / series were included in analysis. In 195 patients included in the five original studies, approximately 20% experienced non-psychosis symptoms following discontinuation of clozapine. In 89 patients in four of the studies, 27 experienced cholinergic rebound, 13 exhibited extrapyramidal symptoms (including tardive dyskinesia), and three had catatonia. In 63 case reports / series included, 72 patients with non-psychosis symptoms were reported, which were catatonia (n=30), dystonia or dyskinesia (n=17), cholinergic rebound (n=11), serotonin syndrome (n=4), mania (n=3), insomnia (n=3), neuroleptic malignant syndrome (NMS) [n=3, one of them had both catatonia and NMS], and de novo obsessive compulsive symptoms (n=2). Restarting clozapine appeared to be the most effective treatment.
CONCLUSIONS: Non-psychosis symptoms following clozapine withdrawal have important clinical implications. Clinicians should be aware of the possible presentations of symptoms to ensure early recognition and management. Further research is warranted to better characterise the prevalence, risk factors, prognosis, and optimal drug dosing for each withdrawal symptom.