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首页> 外文期刊>The journal of clinical psychiatry >Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review.
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Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review.

机译：当前接受氯氮平治疗的患者先前的抗精神病药处方：病例回顾。

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BACKGROUND: Clozapine is indicated for the treatment of resistant schizophrenia, which is usually defined as failure to respond to adequate trials of 2 antipsychotics. It is thought that only clozapine is likely to be effective in such cases and that other drugs are ineffective. We sought to discover prior patterns of antipsychotic prescribing in schizophrenic patients eventually prescribed clozapine. METHOD: Prescribing histories were obtained from prescription charts and case notes for all inpatients prescribed clozapine in 4 hospitals in southeast London during April 2001. RESULTS: 120 patients were identified, of whom 112 had been diagnosed with schizophrenia or schizoaffective disorder and whose data were analyzed. The mean duration of illness was 15.1 years. Subjects had experienced a mean of 9.2 (range, 2-35) episodes of antipsychotic prescription before clozapine was first used, with 5.7 (range, 0-25) episodes constituting adequate trials (drug used at therapeutic dose for 6 weeks). The mean number of different antipsychotics used was 5.5 (range, 1-13), with a mean of 4.0 (range, 0-12) given an adequate trial. Ninety percent of patients (N = 101) had received an atypical antipsychotic before first use of clozapine, and 65% (N = 73) had previously received antipsychotic polypharmacy. The mean maximum theoretical delay in using clozapine was 5.0 years (range, 0-11.1 years). Longer delay was significantly (p <.05) associated with being aged over 30 years at the time of the study, being diagnosed with psychotic illness before the introduction of clozapine, and completing adequate trials of 2 different antipsychotics before the introduction of clozapine or risperidone. CONCLUSION: Clozapine treatment was quite likely delayed for longer than is clinically desirable. This delay may have important effects on quality of life, clinical outcome, and health resource utilization.
机译：背景：氯氮平适用于治疗耐药性精神分裂症，通常定义为对两种抗精神病药物的充分试验无效。据认为在这种情况下仅氯氮平可能有效，而其他药物无效。我们试图发现精神分裂症患者最终开出氯氮平的抗精神病药物处方的先前模式。方法：从2001年4月在伦敦东南部的4家医院的所有处方氯氮平的住院患者的处方表和病例笔记中获得处方历史。结果：确定了120例患者，其中112例被诊断为精神分裂症或精神分裂性情感障碍，并对其数据进行了分析。 。平均病程为15。1年。在首次使用氯氮平之前，受试者经历了平均9.2（2-35范围）发作的抗精神病药处方，其中5.7（0-25范围）发作构成了充分的试验（以治疗剂量使用6周的药物）。经过充分的试验，使用的各种抗精神病药物的平均数为5.5（范围1-13），平均为4.0（范围0-12）。 90％（N = 101）的患者在首次使用氯氮平之前曾接受过非典型的抗精神病药物治疗，而65％（N = 73）的患者先前曾接受过抗精神病药物治疗。使用氯氮平的最大理论平均延迟时间为5.0年（0-11.1年）。在研究时，年龄超过30岁，在引入氯氮平之前被诊断出患有精神病，并在引入氯氮平或利培酮前完成了对两种不同抗精神病药的充分试验，则较长的延误时间显着（p <.05）。 。结论：氯氮平治疗很可能延迟了比临床需要的时间更长的时间。这种延迟可能对生活质量，临床结果和卫生资源利用产生重要影响。

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