Sleep Measures of Patients with Schizophrenia Treated with Risperidone, Clozapine, or Haloperidol

比較服用Risperidone, Clozapine或Haloperidol精神分裂病人之睡眠結構差異

10.29478/TJP.200812.0007

張鈺姍(Yu-San Chang)；林靜妤(Ching-Yu Lin)；陳美月(Mei-Yueh Chen)；陳明招(Ming-Chao Chen)

精神分裂病 ； 睡眠分析 ； 抗精神病藥物 ； antipsychotics ； polysomnography ； schizophrenia

台灣精神醫學

22卷4期（2008 / 12 / 01）

307 - 315

英文

目的：比較服用haloperidol、clozapine或risperidone之精神分裂病患者主觀與客觀睡眠結構之差異。方法：本研究為一橫斷面之研究。收集符合DSM-IV精神分裂病診斷條件的住院患者，服用risperidone 15位、haloperidol 13位與clozapine 12位，比較三組之睡眠結構、簡短精神病症狀評量表(Brief Psychiatric Rating Scale, BPRS)總分與中文版匹茲堡睡眠品質量表(Chinese version of Pisttsburgh Sleep Quality Index, CPSQI)。結果：三組在基本資料、藥物當量、BPRS總分與CPSQI及其分項上之比較並無差異。risperidone與haloperidol二組在第二期睡眠與穩定非動眼期睡眠（stable non-REM sleep，包括第2、3、4期睡眠）皆比clozapine該組少，只有haloperidol 組其第一期睡眠比clozapine組多。結論：精神分裂病患者使用haloperidol、clozapine與risperidone，在主觀之睡眠品質並無差異。Clozapine會增加非動眼期睡眠，特別是第二期睡眠，其對睡眠之影響乃因具有D4與5-HT接受體拮抗劑之作用，未來需要增加個案數且做治療前、後之長期追蹤。

Objective: In this cross-sectional observational study, we intended to compare objective and subjective sleep measures in schizophrenic patients treated with clozapine, risperidone or haloperidol. Methods: We used polysomnography and the Chinese version of Pittsburgh Sleep Quality Index (CPSQI) scores, to compare schizophrenic patients receiving risperidone (n=15), haloperidol (n=13) and clozapine (n=12). All patients were diagnosed according to the DSM-IV criteria, and clinical symptoms were evaluated by Brief Psychiatric Rating Scale (BPRS). Results: No signifi cant differences were found in the comparison of three treatment groups in demographic characteristics, antipsychotic potency, the BPRS scores and CPSQI and its sub-factors. Compared to the clozapine treated group, both haloperidol-and risperidone-treated group had a significantly less stage 2 sleep and less stable non-REM sleep (stage 2, 3 and 4). Only patients treated with haloperidol showed significantly more stage 1 sleep than the clozapine-treated group. Conclusions: Signifi cant differences were not found in subjective perceptions of sleep quality among schizophrenic patients treated with clozapine, risperi-done or haloperidol. Clozapine was found to induce enhancement of non-REM sleep, especially an increase of stage 2 sleep. The D4 and the 5-HT receptor antagonist affinities of clozapine contribute to most of its clinical properties on sleep. Larger patient samples, longitudinal design, and baseline recordings are needed in future studies to confirm of this cross-sectional observational study.

1. American Psychiatric Association(1994).Diagnostic and statistical Manual of Mental Disorders.Washington DC:American Psychiatric Press.
2. Armitage R,Darwynn C,Suppes T,Ozcan ME(2004).Effects of clozapine on sleep in bipolar and schizoaffective disorders.Prog Neuropsychopharmiacol Biol Psychiatry,28,1065-1070.
3. Blum A,Girke W(1973).Marked increase in REM sleep produced by a new anti- psychotic compound.Clin Electrophysiol,38,80-84.
4. Chang YS,Chen TJ,Chen MC,Chen MY(2008).Comparison of risperidons and haloperidol: objective and subjective sleep measures in schizophrenia patients.Taiwanese Journal of Psychiatry,22,107-114.
5. Driver HS,Flanigan MJ,Bentley AJ,Luus HG,Shapiro CM,Mitchell D(1995).The influence of ipsaspirone, a 5-HTIA agonist on sleep patterns of healthy subjects.Psychopharmacology,117,186-192.
6. Dursun SM,Patel JKM,Burke JG(1999).Effects of typical antipsychotic drugs and risperdone on the quality of sleep in patients with schizophrenia: a pilot study.J Psychiatry Neurosci,24,333-337.
7. Dursun SM,Patel JKM,Burke JG,Reveley MA(1999).Effects of typical antipsychotic drugs and risperdone on the quality of sleep in patients with schizophrenia: a pilot study.J Psychiatry Neurosci,24,333-337.
8. Hinze-Selch D,Mullington J,Orth A(1997).Effects of clozapine on sleep: a longitudinal study.Biol Psychiatry,42,260-266.
9. Iber C,Ancoli-Israel S,Chesson A,Quan SF(2007).The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications.Westchester, Illinois:American Academy of Sleep Medicine.
10. Idzikowski C,Mills FJ,Glennard R(1986).5-hydroxy-tryptamine-2-antagonist increases human slow wave sleep.Brain Res,378,164-168.
11. Kaplan HI,Sadock BJ,Grebb JA,Cancro R (eds.),Gabbard GO (eds.),Jones RM (eds.)(1994).Synopsis of psychiatry.New York:Williams & Wilkins Press.
12. Katsuda Y,Walsh AE,Ware CJ,Cowwn PJ,Sharpley AL(1993).Meta-chlorophenyl-piperazine decreases slow-wave sleep in humans.Biol Psychiatry,33,49-51.
13. Keshavan M,Reynolds C,Brar J(1989).Sleep EEG changes in schizophrenia during haloperidol treatment.Biol Psychiatry,25,181.
14. Maixner S,Tandon R,Eiser A(1998).Effects of antipsychotic treatment on polysomnographic measures in schizophrenia: a replication and extension.Am J Psychiatry,155,1600-1602.
15. Meltzer HY,Fatemi SH,Kane JM (eds.),Moller HJ (eds.),Awouters F (eds.)(1996).Serotonergic Mechanisms in Antipsychotic Treatment.New York:Marcel Dekker Press.
16. Miller DD(2004).Atypical antipsychotics: sleep, sedation, and efficiency.J Clin Psychiatry,6(2),3-7.
17. Monti JM,Monti D(2004).Sleep in schizophrenia patients and the effects of anti- psychotic drugs.Sleep Med,8,133-148.
18. Nofzinger EA,Van Kammen DP,Gilbertson MW(1993).Electrocephalographic sleep in clinically stable schizophrenic patients: two-weeks versus six-weeks neuroleptic free.Biol Psychiatry,33,829-835.
19. Overall JE,Gorham DR(1962).The Brief Psychiatric Rating Scale.Psychol Rep,10,799-812.
20. Salin-Pascual RJ,Herrera-Estrella M,GaliciaPolo L(1999).Olanzspine acute administration in schizophrenic patients increases delta sleep and sleep efficiency.Biol Psychiatry,46,141-143.
21. Sharpley AL,Vassalo CM,Cowen PJ(2000).Olanzapine increases stow-wave sleep: evidence for blockade of central 5-HT (2C) receptors in vivo.Biol Psychiatry,47,468-470.
22. Stahl SH(2000).Essential Psychopharmacology, second Edition.Cambridge, UK:Cambridge University Press.
23. Stutzmann JM,Eon B,Lucas M,Blanchard JC,Laduron PM(1992).RP 62203, a 5-hydroxytryptamine 2 antagonist, enhances deep NREM sleep in rats.Sleep in rats Sleep,15,119-124.
24. Taylor SF,Tandon R,Shipley JE(1991).Effects of neuroleptic treatment on polysomnographic measures in schizophrenia.Biol Psychiatry,30,904-912.
25. Touyz SW,Beumont PJ,Saayman GS,Zabow T(1977).A psychophysiological investigation of the short-term effect of clozapine upon sleep parameters of normal young adults.Biol Psychiatry,12,801-822.
26. Tsai PS,Wang SY,Wang MY(2005).Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects.Qual Life Res,14,1943-1952.
27. Wetter TC,Lauer CJ,Gillich G(1996).The electrocephalographic sleep pattern in schizophrenic patients treated with clozapine or classical antipsychotic drugs.J Psychiat Res,30,411-419.
28. Yamashita H,Morinobu S,Yamawaki S,Horiguchi J,Nagao M(2002).Effects of risperidone on sleep in schizophrenia: a comparison with haloperidol.Psychiatry Res,109,137-142.
29. Yamashita H,Most K,Nagao M,Okamoto Y,Morinobu S,Yamawaki S(2004).Effect of changing from typical to atypical antipsychotic drugs on subjective sleep quality in patients with schizophrenia in a Japanese population.J Clin Psychiatry,65,1525-1530.

1. Sui, An-Li,Lin, Mingchun,Chen, Guan-Chin,Chen, Ching-Hao(2011).Is Work Stress Associated with Sleep Quality? Some Findings from Police Officers in Southern Taiwan.台灣精神醫學,25(1),18-25.