tailieunhanh - CLINICAL HANDBOOK OF SCHIZOPHRENIA - PART 4

tiêu chuẩn điều trị thuốc chống loạn thần, và (2) giảm nguy cơ của hành vi tự tử tái phát ở những bệnh nhân tâm thần phân liệt hoặc rối loạn phân liệt, những người được đánh giá là nguy cơ của reexperiencing hành vi tự tử. | 180 III. SOMATIC TREATMENT of standard antipsychotic drug treatment and 2 for reduction of the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at risk of reexperiencing suicidal behavior. One generally accepted norm to establish treatment resistance is failure in at least two trials of antipsychotic drugs for at least 6 weeks each at doses equal to 10-20 mg of haloperidol per day or its equivalent. Treatment-resistant patients often have at least moderate positive negative or disorganization incoherence loose association inappropriate affect and poverty of thought content symptoms and impaired social functioning despite at least two adequate trials of antipsychotic drugs chosen from two or more different classes of these agents. Off-label uses of clozapine sometimes seen in clinical settings include use for patients with unmanageable extrapyramidal symptoms EPS tardive dyskinesia TD refractory bipolar disorder refractory obsessive-compulsive disorder OCD and Parkinson s disease. CLOZAPINE THERAPY INITIATION AND ISSUES RELATED TO EARLY STAGES OF TREATMENT Medical Assessments The patient should have a thorough history and physical examination Table . The history should include information regarding any history of blood dyscrasias seizure disorder cardiovascular disease hepatic and renal disease as well as any immunosuppressive diseases such as HIV. Laboratory testing should include a complete baseline blood count with white blood cell WBC count and absolute neutrophil count ANC complete metabolic assay including serum electrolytes and renal function tests and an electrocardiogram ECG with QTc interval. Clozapine dosing and titration may require modification in individuals with any of the aforementioned preexisting conditions. Patient and Family Education Risks benefits and treatment alternatives should be discussed with the patient and family and documented in the treatment record Table . .