{"title":"氯氮平治疗神经认知障碍","authors":"A. Triest, Rob M. Kok","doi":"10.1002/gps.70099","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi<sup>2</sup> = 14.47, df = 2, <i>p</i> < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.</p>\n </section>\n </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"40 5","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clozapine Treatment in Patients With a Neurocognitive Disorder\",\"authors\":\"A. Triest, Rob M. Kok\",\"doi\":\"10.1002/gps.70099\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi<sup>2</sup> = 14.47, df = 2, <i>p</i> < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.</p>\\n </section>\\n </div>\",\"PeriodicalId\":14060,\"journal\":{\"name\":\"International Journal of Geriatric Psychiatry\",\"volume\":\"40 5\",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Geriatric Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/gps.70099\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Geriatric Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/gps.70099","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：痴呆症的行为和心理症状通常通过药物和非药物干预相结合来治疗，但效果通常是中等的，而且许多患者对治疗有抵抗性。我们的目的是评估神经认知障碍患者使用氯氮平治疗的适应症、反应、副作用、氯氮平停药的频率、停药的原因和停药的时间。方法回顾性队列研究，纳入荷兰一家精神病院老年科2011年至2020年间接受氯氮平治疗的所有神经认知障碍患者。临床总体印象改善量表（CGI-I）用于评估治疗反应，基于患者电子档案中的临床记录。还从患者档案中提取了有关氯氮平停药的副作用和变量。结果我们纳入了81例住院患者，他们开始使用氯氮平并有严重的神经认知障碍。27例患者出现临床相关阳性治疗反应（CGI-I评分1-2）。与伴有神经认知障碍的谵妄患者相比，无谵妄患者的预后有统计学意义上的显著改善(Chi2 = 14.47, df = 2, p <；0.0001)。81例患者中仅有79例出现不良反应，2例出现严重不良反应。11例患者因副反应主要停药，7例患者无疗效，5例患者副反应合并无疗效。氯氮平的中位剂量仅为50mg /天，较高的剂量是较短治疗时间的显著预测因子。结论氯氮平对无谵妄叠加的神经认知障碍合并BPSD患者可能是一种安全有效的干预手段。低剂量氯氮平可能是重度难治性BPSD的一种治疗选择。
Clozapine Treatment in Patients With a Neurocognitive Disorder
Objectives
Behavioural and Psychological Symptoms of Dementia (BPSD) are usually managed with a combination of pharmacological and nonpharmacological interventions, but efficacy is often moderate, and many patients are treatment-resistant. We aimed to evaluate the indication for treatment with clozapine, response, side effects, frequency of clozapine discontinuation, reasons for discontinuation and time to discontinue clozapine in patients with a neurocognitive disorder.
Methods
A retrospective cohort study including all patients with a neurocognitive disorder who started with clozapine between 2011 and 2020, admitted to old age departments of a psychiatric hospital in The Netherlands. The Clinical Global Impression of Improvement-scale (CGI-I) was used to evaluate treatment response, based on clinical notes in the electronical patients' files. Side effects and variables concerning discontinuation of clozapine treatment were also extracted from patients' files.
Results
We included 81 inpatients who started with clozapine and had a major neurocognitive disorder. A clinically relevant positive treatment response (CGI-I score 1-2) was found in 27 patients. Patients without a delirium have a statistically significantly better outcome compared to patients with a delirium superposed on a neurocognitive disorder (Chi2 = 14.47, df = 2, p < 0.0001). Only 79 side effects were reported in these 81 patients, and severe side effects in only 2 patients. Side effects were the primary reason to discontinue clozapine in 11 patients, lack of efficacy in 7 patients and side effects combined with lack of efficacy in 5 patients. The median clozapine dose was only 50 mg/day, and a higher dose was a significant predictor of a shorter treatment duration.
Conclusion
Clozapine may be an effective and safe intervention for patients with a neurocognitive disorder and BPSD without a superposed delirium. Clozapine at a low dose may be a treatment option for severe, treatment resistant BPSD.
期刊介绍：
The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers.
The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
