精神分裂症病患服用clozapine表現強迫症狀

Obsessive Symptoms in a Schizophrenic Patient Treated with Clozapine

報告一難治型精神分裂症病患採用clozapine治療後產生強迫症狀之治療經過，並探討藥物治療與些症狀之相關性。一現年31歲男性精神分裂症病患因難治之幻聽及關係妄想而接受clozapine治療，於300mg/d維持治療四年五個月後，產生反覆檢查之強迫症狀，而造成其本身情緒上之痛苦，家庭關係緊張，且無法從事家中經營之小吃店工作。經轉換藥物至zotepine 300mg/d並佐以sertraline 150mg/d，於四週後其精神症狀及強迫症狀均改善，並回複部分社會功能。強迫症狀對於本例病患之社會及職業功能有明顯影響，因使用新一代抗精神病藥物時，可能促發或惡化此症狀，故於使用血清素受體阻斷作用明顯之精神科治療藥物時應審慎評估其強迫症狀以及症狀對社會功能之影響。

To report the obsessive-compulsive symptoms after administrating clozapine in a treatment-refractory schizophrenic patient, and to discuss the relationship between the pathogenesis and the treatment. A 31-year-old male schizophrenic patient received clozapine due to treatment-refractory auditory hallucination and delusion of reference. He began to suffer from obsessive-compulsive symptoms such as fear and checking after maintenance treatment with clozapine 300mg/d for 4 years and 5 months. These symptoms tortured him very much, tensed tip his interaction with the family. and hindered him from doing casual work w ell in the restaurant. After shifting his medication to zotepine 300mg/d and sertraline 150mg/d, the clinical symptoms, both ill psychotic and obsessive-compulsive symptoms, and his social function improved 4 weeks later. Obsessive-compulsive symptoms had significant impact to our patients social awl occupational function. Evidences suggest novel antipsychotics might induce or worse obsessive-compulsive symptoms. Cautious assessment about obsessive-compulsive symptoms awl their impact to social function ca be of benefit before administrating ailtipsychotic with high serotonin antagonism.