Schizophrenia, Drug Therapy, and Monitoring
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In his article on schizophrenia, Freedman (Oct. 30 issue)1 may have understated the relative benefits of clozapine, which has proven advantages over other antipsychotic drugs in mitigating refractory positive and negative symptoms,2 aggression,3 and suicidal behaviors.4 The risk of agranulocytosis and the associated requirement of blood monitoring may reasonably delay the use of clozapine until a trial of at least one other agent has been completed, but clozapine is underused in the treatment of schizophrenia.5 Reasons for this underuse may include both the inconvenience of blood monitoring to reduce the risk of agranulocytosis and physicians' inexperience with the management of associated side effects.6 The increased risk of myocarditis and seizures among patients receiving clozapine necessitates careful monitoring and probably reduces the frequency with which it is used. However, until other therapeutic agents match the efficacy of this drug in the most severely ill patients with schizophrenia, greater use of clozapine should be a goal in the treatment of this debilitating brain disorder.
Daniel W. Bradford, M.D.
T. Scott Stroup, M.D., M.P.H.
University of North Carolina School of Medicine
Chapel Hill, NC 27599
dbradford@unc.edu
Editor's note: Dr. Bradford reports having received honoraria from Bristol-Myers Squibb. Dr. Stroup reports having received honoraria from Janssen and Bristol-Myers Squibb and research support from Lilly.
References
Freedman R. Schizophrenia. N Engl J Med 2003;349:1738-1749.
Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789-796.
Citrome L, Volavka J, Czobor P, et al. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr Serv 2001;52:1510-1514.
Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003;60:82-91. [Erratum, Arch Gen Psychiatry 2003;60:735.
Taylor DM, Young C, Paton C. Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review. J Clin Psychiatry 2003;64:30-34.
Lieberman JA. Maximizing clozapine therapy: managing side effects. J Clin Psychiatry 1998;59:Suppl 3:38-43.
To the Editor: In the review article on schizophrenia, there is no mention of coexisting human immunodeficiency virus (HIV) infection. Recent research in the United States has shown alarmingly high rates of HIV infection, ranging from 9 to 19 percent, among people with serious and enduring mental disorders. HIV infection in people with schizophrenia is a serious but largely ignored part of the HIV epidemic, and people with schizophrenia should be considered at risk for HIV infection.1 These patients are intrinsically difficult to treat; in addition, multiple interactions between antiretroviral and antipsychotic drugs limit the choice of antipsychotic drugs. Given these problems, I suggest that testing for HIV infection in persons with schizophrenia be encouraged.
Giuseppe Vittorio Luigi De Socio, M.D.
University of Perugia
06122 Perugia, Italy
gvldesocio@libero.it
References
Gray R, Brewin E, Noak J, Wyke-Joseph J, Sonik B. A review of the literature on HIV infection and schizophrenia: implications for research, policy and clinical practice. J Psychiatr Ment Health Nurs 2002;9:405-409.
Daniel W. Bradford, M.D.
T. Scott Stroup, M.D., M.P.H.
University of North Carolina School of Medicine
Chapel Hill, NC 27599
dbradford@unc.edu
Editor's note: Dr. Bradford reports having received honoraria from Bristol-Myers Squibb. Dr. Stroup reports having received honoraria from Janssen and Bristol-Myers Squibb and research support from Lilly.
References
Freedman R. Schizophrenia. N Engl J Med 2003;349:1738-1749.
Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789-796.
Citrome L, Volavka J, Czobor P, et al. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr Serv 2001;52:1510-1514.
Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003;60:82-91. [Erratum, Arch Gen Psychiatry 2003;60:735.
Taylor DM, Young C, Paton C. Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review. J Clin Psychiatry 2003;64:30-34.
Lieberman JA. Maximizing clozapine therapy: managing side effects. J Clin Psychiatry 1998;59:Suppl 3:38-43.
To the Editor: In the review article on schizophrenia, there is no mention of coexisting human immunodeficiency virus (HIV) infection. Recent research in the United States has shown alarmingly high rates of HIV infection, ranging from 9 to 19 percent, among people with serious and enduring mental disorders. HIV infection in people with schizophrenia is a serious but largely ignored part of the HIV epidemic, and people with schizophrenia should be considered at risk for HIV infection.1 These patients are intrinsically difficult to treat; in addition, multiple interactions between antiretroviral and antipsychotic drugs limit the choice of antipsychotic drugs. Given these problems, I suggest that testing for HIV infection in persons with schizophrenia be encouraged.
Giuseppe Vittorio Luigi De Socio, M.D.
University of Perugia
06122 Perugia, Italy
gvldesocio@libero.it
References
Gray R, Brewin E, Noak J, Wyke-Joseph J, Sonik B. A review of the literature on HIV infection and schizophrenia: implications for research, policy and clinical practice. J Psychiatr Ment Health Nurs 2002;9:405-409.