정신분열병 및 기타 정신증적 장애로 일 종합병원에 입원한 환자의 치료에서 Clozapine의 사용의 실태 : 유효성 및 부작용
The Clinical Practice of clozapine in the Treatment of Inpatients with Schizophrenia and Other Psychotic Disorders : Effect and Side Effect
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초록
clozapine은 기존의 항정신병약물에 반응하지 않는 치료저항성 정신분열병 환자의 증상의 개선에 효과적으로 사용할수 있었으나, 환자의 32.1%에서만 반응을 보여 치료에 대한 반응은 제한적이었다.. 또한 부작용의 측면에서는 이전의 보고들과 유사하였으나 경련의 발생빈도가 이전의 국내보고에 비해 높게 관찰되었으며, 이는 myoclonic jerk의 높은 빈도에 기인하였다.본 연구는 clozapine의 효능과 부작용을 평가하기 위해 계획된 연구가 아니라 후향적으로 의무기록을 검토하여 조사한 연구이라 많은 제한점을 가진다. 특히 증상의 호전과 부작용의 평가는 각 평가자들간의 변이가 있을 수 있고 그것이 본 연구의 결과에 영향을 줄 수 있었다는 것과 입원 당시의 기록만을 대상으로 하여 장기간의 추적관찰이 이루어지지 않았다는 것이 큰 한계점이다. 따라서, 본 연구의 결과를 일반화하는데는 보다 정확한 추후 연구가 필요하다고 생각된다.
Abstract
Object : Clozapine is effectively used to treat treatment-resistant schizophrenia patients. Researchers have been conducted on the usage, effects, side effects and the amount of use in the actual clinical practice. Method : Research is one by the retrospective review of medical records of 53 patients, who were admitted at the department of neuropsychiatry of Maryknoll general hospital from Jan 1, 1997 until Apr 31, 2002 and were treated clozapine afterward. Result : The average age of the patients was 30.6±8.6year and the average duration of illness was 9.1±6.9years and the number of admission history was 2.4±2.0. The prior number of antipsychotics use is average 2.6±0.9. Fifty patients were diagnosed schizophrenia. For the reason of usage, forty-seven patients(88.7%) were resistant to prior antipsychotics and average duration of admission was 66.2±31.1 days since the administration. When comparing PANSS score before and after the administration, at the moment of getting out the hospital, the symptom has improved in the PANSS positive, negative, and total score. When the treatment-response group, which defines that the PANSS total score improves over 25%, 32.1%(17patients) of the group showed progress in the drug treatment. The side effects were hypersalivation, sedation, weight gain over 7%, constipation, seizure, fever, dizziness, enuresis, abnormal LFT, vomiting, palpitation, and dry mouth in frequency order. Conclusion : Clozapine is effective to the treatment-resistant schizophrenia, but the effect is limited. In terms of the side effects seizure has been detected at a higher frequency and also myoclonic jerk has at a higher frequency either. The thing that should not be overlooked is that myoclonic jerk could progress to generalized seizure.