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氯氮平是一种作用强,疗效快的新型抗精神病药.它不但对幻觉妄想,紧张症有效,而且对部分老大难精神分裂症病例亦有一定的疗效.但是在文献上尚未见到氯氮平加重精神症状的报道。现将观察到因口服氯氮平而加重精神症状的1例报道如下。患者,女,27岁。因表现沉默少言,不敢出门,不与外人接触,与父母感情疏远,猜疑被害伴消极言语等,于1992年10月5日入院,入院查体无异常。精神检查;接触被动,呆滞,情感淡漠,猜疑有监视.诊断精神分裂症。给氯丙嗪治疗。10月8日出现自伤及毁物而合并氟哌啶醇治疗。除接触稍改善外.其它症状未见明显改变,故加大药量。数天后病人出现动眼危象,四肢僵硬,头颈扭转,运作迟缓。虽口服安坦片症状仍未消除.故于10月29日改服氯氮平100mg/d,2天后病人出现行为紊乱,不知羞涩,将热水浇于父亲头部。并认为受他人监视.因精神症状加重立即停服氯氮平改用氯丙嗪和氟哌啶醇。精神症状又趋平稳.此后不久副作用再度出现。因患者对服用此类药产生反感,乃至于12月8日又改服氯氮平100mg/d治疗,2天后精神症状又见加重,出现叩头跪拜、紧张、恐惧现象,认为受人监视,跳进河里洗不清,频频向医务人员求救.因病情恶化,故再一次停用氯氮平。氯氮平作为一种抗精神药物,疗效可与吩噻嗪类相媲美。目前在欧洲已受到重视.一般印象认为不会促使精神症状恶化。但本病例在住院过程中,先后二次试用氯氮平都引致精神症状明显加重,停药后好转,看来并非偶然巧合.因而护理上要认真观察病人的病情变化及言谈举止,从而减少病人的痛苦.从氯氮平的副反应和对脑电图的影响看来,与吩噻嗪等抗精神病药有所不同,但本病例招致精神症状的机制究竟如何,尚待今后研究阐明。(1996—03—07收稿)
Clozapine is a new type of antipsychotic with strong effect and quick curative effect.It is not only effective for hallucination and catastrophic disease but also has some curative effect on some cases of chronic schizophrenia.However, no chlorine has been found in the literature Nitrogen levels increase mental symptoms reported. One case of psychiatric symptoms that are exacerbated by oral clozapine will now be reported as follows. Patient, female, 27 years old. Due to the performance of silent few words, afraid to go out, do not contact with outsiders, estranged feelings with their parents, suspicion of murder with negative words, etc., on October 5, 1992 admission, admission examination was normal. Mental examination; contact passive, sluggish, emotional indifference, suspicion of surveillance. Diagnosis of schizophrenia. Give chlorpromazine treatment. October 8 appeared self-injury and destruction of the combined haloperidol treatment. In addition to a slight improvement in contact with other symptoms no significant change, so increase the dose. A few days later the patient appeared blinking, limbs stiff, head and neck twisted, slow operation. Although the symptoms of oral administration of Antan still not eliminated.Therefore, on October 29 to change clozapine 100mg / d, 2 days after the patient behavior disorder, I do not know shy, pouring hot water in his father’s head. And considered by others to monitor because of aggravated mental symptoms stopped taking clozapine switch to chlorpromazine and haloperidol. Mental symptoms have stabilized, and shortly afterwards side effects appear again. Because of the patient to take such drugs have aversion, and even on December 8 and change service clozapine 100mg / d treatment, 2 days after the onset of mental symptoms, see kowtow, kneeling, nervous, fear phenomenon, that people being monitored, jumping Into the river unclear, frequently to the medical staff for help. Due to the deterioration of the condition, it once again disable clozapine. Clozapine as an antipsychotic can be treated with phenothiazines comparable. At present, attention has been paid in Europe, and the general impression is that it will not worsen the mental symptoms. However, this case during hospitalization, has repeatedly tried clozapine two have significantly increased mental symptoms, improved after stopping, it seems not accidental coincidence .Therefore care should be carefully observed the patient’s condition and speech behavior, thereby reducing the patient Of the pain from the side effects of clozapine and the impact on the electroencephalogram seems phenothiazine and other antipsychotics are different, but in this case the mechanism of mental symptoms, what remains to be elucidated in the future. (Received 1996-03-07)