精神分裂症是一种临床常见的精神疾病,通常推荐抗精神病药单药治疗。当其发展为难治性精神分裂症时,预后更差,治疗难度更大,因此临床常采用联合治疗方案。氯氮平作为第二代抗精神病药物被公认为治疗难治性精神分裂症的最佳药物,但其副作用大,且一部分难治性精神分裂症患者对氯氮平治疗不敏感。既往有研究认为氯氮平与其他精神药物联用,能使患者在炎症因子、血糖血脂水平等不同方面获益的同时,达到协同增效作用,降低氯氮平使用剂量,从而有效降低不良反应发生率。另外,氯氮平与MECT联用时不仅可改善患者脑血流灌注,还对氯氮平抵抗的难治性精神分裂症同样有效。因此本文就氯氮平对难治性精神分裂症的联合治疗方案展开综述,以期为临床联合治疗方案的选择提供参考。Schizophrenia is a clinically common psychiatric disorder, and antipsychotic monotherapy is usually recommended. When it develops into refractory schizophrenia, the prognosis is worse and the treatment is more difficult, so the clinical combination treatment is often used. As a second-generation antipsychotic, clozapine has been recognized as the best drug for the treatment of refractory schizophrenia, but its side effects are large, and some patients with refractory schizophrenia are not sensitive to clozapine treatment. Previous studies have suggested that the combination of clozapine and other psychotropic drugs can benefit patients in different aspects such as inflammatory factors, blood glucose and lipid levels, while achieving a synergistic effect and reducing the dosage of clozapine, thus effectively reducing the incidence of adverse reactions. The combination of clozapine and MECT can not only improve cerebral blood perfusion in patients, but also be effective in clozapine-resistant refractory schizophrenia. Therefore, this article reviews the combined treatment of clozapine for refractory schizophrenia, in order to provide reference for the selection of clinical combined treatment.
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