Klozapin Tedavisine Yeterli Yanıt Alınamayan Tedaviye Dirençli Şizofreni Hastalarında Pimozidle Güçlendirme Yaklaşımı: Geriye Dönük Bir Değerlendirme Çalışması

Abstract

Objective: In this retrospective chart review study we aimed to investigate the effect of pimozide augmentation on schizophrenia patients with poor or partial response to clozapine therapy. Methods: Charts of 17 treatmentresistant schizophrenia patients who had poor or partial response to at least oneyear clozapine therapy and whose treatment was augmented with pimozide were evaluated. Patients who had Clinical Global ImpressionSeverity (CGIS) scores ≥4 and Positive and Negative Syndrome Scale (PANSS) scores ≥72 were considered as poor or partial clozapine responders. The scores on the PANSS, CGI scale, and Extrapyramidal Symptom Rating Scale (ESRS) obtained in the first and the third months of followup were evaluated. Results: The mean age of the 8 female and 9 male (total 17) patients was 32.23±7.87 years, the mean age at onset of illness was 19.94±4.19 years, the mean duration of illness was 12.29±6.12 years, the mean clozapine dose was 500±58.63 mg/day, and the mean pimozide dose was 3.88±0.60 mg /day. The mean PANSS scores decreased from 99.70±13.91 to 3.64±1.27 and the mean CGIS scores decreased from 4.82±0.80 to 3.64±1.27. ESRS scores did not change significantly after the addition of pimozide to the treatment. Conclusion: Pimozide augmentation of clozapine was found to be effective and safe in treatmentresistant schizophrenia patients with poor or partial response to clozapine therapy. (Archives of Neuropsychiatry 2010; 47: 302-6) Amaç: Bu çal›flmada klozapin tedavisine yan›t vermeyen ya da k›smi yan›t veren tedaviye dirençli flizofreni hastalar›nda klozapin tedavisini pimozid ile güçlendirme yaklafl›m›n›n etkisinin geriye dönük kay›t taramas› yöntemiyle ortaya konmas› amaçlanm›flt›r.Yöntemler: Çal›flma verileri klini¤imizde yatarak ya da ayaktan tedavi gören tedaviye dirençli flizofreni tan›s› ile en az 1 y›ld›r klozapin kullanan ve klozapin tedavisine yan›t vermeyen ya da k›sm› yan›t veren hastalarda tedaviye güçlendirme amac›yla pimozid eklenmifl hastalar›n dosyalar›ndan al›nd›. Hastalar›n Klinik Global ‹zlenim fiiddet alt ölçe¤i (KG‹fi) ≥4 ve Pozitif ve Negatif Sendrom Ölçe¤i (PANSS) ≥72 olmas› "klozapin tedavisine yan›t vermeyen ya da k›sm› yan›t veren" biçiminde de¤erlendirildi. Klozapin tedavisine pimozid eklenmifl araflt›rma ölçütlerine uyan, verileri tam olan 17 hastaya bafllang›çta, 1. ve 3. aylarda uygulanm›fl PANSS, KG‹ ve Ekstrapiramidal Belirtileri De¤erlendirme Ölçe¤i (EBDÖ) sonuçlar› de¤erlendirildi. Bulgular: Çal›flmay› al›nan 17 hastan›n yafl ortalamas› 32.23±7.87'idi. 8'i kad›n ve 9'u erkekti. Ortalama flizofreni bafllang›ç yafl› 19.94±4.19 ve ortalama ruhsal hastal›k süresi 12.29±6.12 idi. Klozapin kullan›m süresi 3.70±2.75 y›l olarak saptand›. Klozapin kullan›m dozu ortalama 500±58.63 mg/gün iken eklenen pimozid dozu ortalama 3.88±0.60 mg/gün idi. Bafllang›çta ve 3. ayda yap›lan PANSS ölçümleri 99.70±13.91'den 71.17±25.92'ye düflme gösterirken, ayn› flekilde KG‹fi ölçümlerinin de 4.82±0.80'den 3.64±1.27'ye düfltü¤ü saptand›. EBDÖ ölçümlerinde pimozid eklenmesiyle anlaml› bir de¤ifli...