住院精神分裂症病人對典型抗精神病藥物反應之預測因子

10.29478/TJP.200409.0004

林清華；陳偉任；余伍洋；陳明招

治療不反應 ； 發病年齡 ； 精神分裂症

台灣精神醫學

18卷3期（2004 / 09 / 01）

200 - 205

繁體中文

目的：Clozapine開始使用後，精神分裂症病人對典型抗精神藥物的反應變得很重要。本研究之目的在比較不反應、或反應病人各項變數的差異，探討對典型抗精神藥物反應的預測因子。方法：符合精神分裂症診斷之病患271位，回顧病歷，記錄基本病史資料。（一）142位不反應組病人：（1）曾用過至少兩類典型抗精神病藥物。（2）每一種藥物劑量至少每天CPZ相當量800 mg以上，至少6週仍無有效臨床反應者。（二）129位反應組病人：（1）符合出院條件。（2）從未服用過clozapine或risperidone，且未曾接受過電氣痙攣療法。（3）入院時及出院前評估BPRS，選取BPRS分數減少大於30%者，以t檢定、卡方檢定、對數迴歸分析。結果：不反應組的結婚比率較低、家族罹患精神分裂症比率較高、發病年齡較早、及住院次數較多。以對數迴歸分析顯示，發病年齡愈早、住院次數愈多，為對典型抗精神病藥物不反應的顯著預測因素。結論：住院次數與發病年齡呈負相關，本研究顯示，發病年齡是對典型抗精神病藥物反應與否最重要的因素。

1. Bartko, G.,Frecska, E.,Horvath, S.,Zador, G.,Arato, M.(1990).Predicting neuroleptic response from a combination of multilevel variables in acute schizophrenic patients.Acta Psychiatr Scand,82,408-41.
2. Conley, R.R.,Kelly, D.L.(2001).Management of treatment resistance in schizophrenia.Biol Psychiatry,50,898-911.
3. De Lisi, L.E.(1992).The significance of onset for schizophrenia.Schizophr Bull,18,209-15.
4. Dernovsek, M.Z.,Tavcar, R.(1999).Age at onset of schizophrenia and neuroleptic dosage.Soc Psychiatry Paychiatr Epidemiol,34,622-6.
5. Eaton, W.W.,Bilker, W.,Haro, J.M.(1992).Long-term course of hospitalization for schizophrenia. I. Risk for rehospitalization.Schizophr Bull,18,217-28.
6. Glick, M.,Mazure, C.M.,Bowers, M.B.,Zigler, E.(1993).Premorbid social competence and the effectiveness of early neuroleptic treatment.Compr Psychiatry,34,396-401.
7. Gureje, O.(1991).Gender and schizophrenia: age at onset and sociodemographic attributes.Acta Psychiatr Scand,83,402-5.
8. Harrow, M.,Sands, J.R.,Silverstein, M.L.(1977).Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study.Schizophr Bull,23,287-303.
9. Hegarty, J.D.,Baldessaini, R.J.,Tohen, M.,Waternaux, C.,Oepen, G.(1994).One hundred years of schizophrenia: a meta-analysis of the outcome literature.Am J Psychiatry,151,1409-16.
10. Hori, A.,Tsunashima, K.,Takekawa, Y.,Ishihara, I.,Terada, T.,Uno, M.(1999).Criteria defining refractory schizophrenia.Acta Psychiatr Scand,99,141-7.
11. Kane, J.M.,Honigfeld, G.,Singer, J.,Meltzer, H.(1988).Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine.Arch Gen Psychiatry,45,789-96.
12. Kawanishi, Y.,Tachikawa, H.,Suzuki, T.(2000).Pharmacogenomic and schizophrenia.Eur J Pharmacol,410,227-41.
13. Kolkowska, T.,Willams, A.O.,Ardem, M.(1958).Schizophrenia with good and poor outcome, I: early clinical features, response to neuroleptics and signs of organic dysfunction.Br J Psychiatry,146,229-39.
14. Meltzer, H.Y.(1997).Treatment-resistant schizophrenia: the role of clozapine.Curr Med Res Opin,14,1-20.
15. Meltzer, H.Y.,Rabinowitz, J.,Lee, M.A.(1997).Age at onset and gender of schizophrenic patients in relation to neuroleptic resistance.Am J Psychiatry,154,475-82.
16. Nimgaonkar, V.L.,Wesseley, S.,Tune, L.E.,Murray, R.M.(1988).Response to drugs in schizophrenia: the influence of family history, obstetric complications and ventricular enlargement.Psychol,18,583-92.
17. Overall, J.E.,Gorham, D.R.(1962).The brief psychiatric rating scale.Psychol Rep,10,700-812.
18. Pearlson, G.D.,Kreger, L.,Rabins, P.(1989).A chart review study of late-onset and early-onset schizophrenia.Am J Psychiatry,146,1568-74.
19. Peuskens, Joseph(1999).The evolving definition of treatment resistance.Jclin Psychiatry,60(12),4-8.
20. Pinals, D.A.,Malhotra, A.K.,Missar, C.D.,Pickar, D.,Breier, A.(1996).Lack of gender differences in neuroleptic response in patients with schizophrenia.Schizophr Res,22,215-22.
21. Rabinowitz, J.,Lichtenberg,Kaplan, Z.,Mark, M.,Nahon, D.,Davidson, M.(2001).Rehospitalization rates of chronically ill schizophrenic patients discharged on a regimen of risperidone, olanzapine, or conventional antipsychotics.Am J Psychiatry,158,266-9.
22. Sadock, B.J.(Ed.),Sadock, V.A.(Ed.)(1994).Kaplan & Sadock's Synopsis of Psychiatry.Baltimore:Lippncott Williams & Wilkins.
23. Szymanski, S.,Liberman, J.A.,Alvir, J.M.(1995).Gender differences in onset of illness, treatment response, course, and biological indexes in first-episode schizophrenic patients.Am J Psychiatry,152,698-703.
24. Thara, R.,Srinivasan, T.N.(1997).Outcome of marriage in schizophrenia.Soc Psychiatry Paychiatr Epidemiol,32,416-20.
25. 林喬翔、胡海國(1993)。精神分裂症患者急性期對藥物治療反應之相關因子研究。中華精神醫學，7，97-104。
26. 楊寬弘、周煌智、張和平、余伍祥(1996)。精神病患層級區分與病房分類：增加病床轉換率的方法。中華精神醫學，10，259-67。