氯氮平戒断的非精神病症状:一项系统综述

Q3 Medicine
B Yee, J C L Looi, M Agaciak, S Allison, S K W Chan, T Bastiampillai
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引用次数: 1

摘要

目的:氯氮平是一种具有复杂受体谱的强效抗精神病药物。它是为难治性精神分裂症保留的。我们系统地回顾了氯氮平戒断引起的非精神病症状的研究。方法:使用关键词“氯氮平”、“戒断”或“超敏感”、“停止”、“反弹”或“停药”对CINAHL、Medline、PsycINFO、PubMed和Cochrane系统评价数据库进行检索。包括氯氮平戒断后的非精神病症状相关的研究。结果:5项原始研究和63例病例报告/系列纳入分析。在五项原始研究的195名患者中,大约20%的患者在停用氯氮平后出现非精神病症状。在四项研究的89例患者中,27例出现胆碱能反弹,13例出现锥体外系症状(包括迟发性运动障碍),3例出现紧张症。在纳入的63例病例报告/系列中,有非精神病症状的患者72例,分别为紧张症(n=30)、肌张力障碍或运动障碍(n=17)、胆碱能反弹(n=11)、血清素综合征(n=4)、躁狂(n=3)、失眠(n=3)、抗精神病药恶性综合征(NMS) [n=3,其中1例同时有紧张症和NMS]、新生强迫症(n=2)。重新使用氯氮平似乎是最有效的治疗方法。结论:氯氮平停药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可能出现的症状,以确保早期识别和管理。进一步的研究是必要的,以更好地描述患病率、危险因素、预后和最佳药物剂量的每一个戒断症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review.

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.

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来源期刊
East Asian Archives of Psychiatry
East Asian Archives of Psychiatry Medicine-Medicine (all)
CiteScore
1.60
自引率
0.00%
发文量
13
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