以高劑量Quetiapine治療對Quetiapine劑量600毫克治療反應不佳的精神分裂症患者

High-dose Quetiapine for the Treatment of Schizophrenia with Inadequate Response to Quetiapine 600 mg/day

目的：對quetiapine 劑量600 毫克治療超過四週，仍療效不佳的台灣精神分裂症病人， 評估以每日劑量高於或等於800 毫克quetiapine 治療的效果。方法：持續六週的開放標籤 研究；以臨床整體印象－－嚴重度、簡短精神症狀量表與錐體外症狀評量表評估療效及副作 用。結果：共六名個案參與。六週後，quetiapine 平均劑量每日1000 毫克。簡短精神症狀 量表與臨床整體印象－－嚴重度平均分別由44.2±5.5 降到35.5±18.1 與4.7±0.8 降到3.7 ±1.8。四名個案達到治療有效的標準，且無個案呈現嚴重不良反應。結論：雖然因為個案 數少，簡短精神症狀量表與臨床整體印象－－嚴重度沒有統計上顯著改善，但平均分數仍 分別有19.7% 與21.3% 的降低，且有66.7% 的個案達到治療有效的標準。故對每日劑量600 毫克quetiapine 治療反應差的台灣精神分裂症患者，高劑量quetiapine 可能有效且有良好 耐受性。

Objectives: In this study, we aimed to determine the effi cacy of high-dose quetiapine (≧800 mg/day) for Taiwanese patients with schizophrenia and with inadequate response to quetiapine 600 mg/day of more than 4 weeks. Methods: The study was a six-week, open-label study. We assessed patients’ treatment response and side effects with clinical global impression-severity (CGI-S), brief psychiatric rating scale (BPRS), and extrapyramidal syndrome rating scale (ESRS). Results: Six patients participated in this study. After this six-week study, the mean dose of quetiapine was 1000 mg/day. The mean scores of BPRS and CGI-S were improved from 44.2 ± 5.5 to 35.5 ± 18.1 (p=0.344) and 4.7 ± 0.8 to 3.7 ± 1.8 (p=0.084), respectively. Four patients met the criteria of treatment responder and no patients suffered from severe adverse events. Conclusion: Although no signifi cant statistical differences in this study were observed due to small sample size, the improvements of mean total scores of BPRS and CGI-S were 19.7% and 21.3%, respectively, and 66.7% of the patients met treatment responder criteria. For Taiwanese patients with schizophrenia and with inadequate treatment response to quetiapine 600 mg/day, we suggest that high-dose quetiapine can be effective and tolerable.