Alkan Hatice AKDAĞ, Cebrail KISA, Erol GÖKA

Klozapine dirençli şizofreni hastalarında güçlendirme yaklaşımları: Bir gözden geçirme

Klozapin tedaviye dirençli şizofreni hastalarında etkinliği kanıtlanmış bir atipik antipsikotiktir. Bununla birlikte, klozapin tedavisine de yanıt vermeyen şizofreni ve şizoaffektif bozukluk tanısı konmuş hasta oranı %40-70 gibi oldukça yüksektir. Bu nedenle klozapin tedavisine dirençli şizofreni hastalarında yeni tedavi yaklaşımları geliştir-mek amacıyla çalışmalar yapılmaktadır. Çeşitli psikofarmakolojik ajanlarla yapılan çalışma sonuçları klozapinin ötesinde de tedavi alternatiflerinin olabileceğine ilişkin güçlü olmayan kanıtlar sunmaktadır. Klozapinin kesilmesi, bir diğer psikotrop ilaç başlanması ya da klozapinin bir diğer ilaçla kombinasyonu konularında bir ajanı diğerlerine göre ayrıcalıklı tutmak mevcut bilgilerle henüz olası değildir. Yapılan kontrollü çalışmaların sonucuna ve klinisyen-lerin uygulamalarına bakıldığında, daha çok öncelikli olarak klozapin tedavisine ek olarak güçlendirme yaklaşımla-rının yeğlendiği görülmektedir. Bu amaçla tipik ya da atipik antipsikotikler, antidepresanlar, duygudurum düzenle-yiciler, N-Metil-D-Aspartat (NMDA) reseptör agonistleri gibi birçok farmakolojik ajan ve elektrokonvulsif tedavi (EKT) ile klozapin tedavisini güçlendirme yaklaşımlarının olduğu görülmektedir. Bu konuda bugüne kadar yapılmış ulaşabildiğimiz kontrollü çalışmalar, açık çalışmalar ve olgu bildirimleri gözden geçirilerek bu yazı hazırlandı. Bu gözden geçirme yazısının amacı tedaviye dirençli şizofreni hastalarında ideal tedavi yaklaşımı olarak değerlendiri-len klozapin tedavisine de yanıt vermeyen ya da kısmi yanıt veren hastalarda psikofarmakolojik yaklaşımın ne olacağı konusunda klinisyenlere bir yol haritası çizmektir.

Augmentation approaches in scizophrenic patients resistant to clozapine: A review

Clozapine is atypical antipsychotic whose efficacy in schizophrenic patients refractory to treatment has been proven. However, the proportion of patients diagnosed with schizophrenia and schizoeffective disorder and who do not respond to clozapine treatment is quite high, namely 40-70%. Therefore studies are carried out in order to develop new treatment approaches in scziophrenic patients resistant to clozapine treatment. The results of various studies carried out with various psychopharmological agents provide inconclusive evidence that treament options other than clozapine may be present. Given available information at present, it is not posssible to considere one drug superior to another and hence to discontinue clozapine, commence another psychotropic drug or to combine clozapine with another drug. However, according to the results of controlled studies or practice of clinicians, it is seen that augmentation approaches in addition to clozapine treatment are preferred. There are various approaches aiming to augmentation clozapine treatment such as atypical antipsyhotics, antidepressants, affective regulation agents, N,Methyl-d-aspartat (NMDA) receptor agonists. The aim of this article to guide clinicians in what psycholopharmocological approaches can be used in patients who do not respond to clozapin treatment or respond to it partially, which is regarded as optimal treatment approach in schizophrenic patients resistant to treatment. The purposes of the present article to rewiew avaible controlled studies, open studies anc case reports in literature about clozapine-resistant schizophrenic patients.

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