만성정신분열병 환자에서 항정신병 약물과 병합한 Lithium의 임상적 효과

The Clinical Effects of Lithium Combined w ith Antipsychotics in the Chronic Schizophrenics

The authors studied the clinical effects of Lithium combined with antipsychotics in 24 subjects who were diagnosed as chronic schizophrenia according to DSM-III criteria ; they had not responded well to 2 or more classes of antipsychotics. And they have been maintained on the same dose for more than 2 weeks prior to this study. This study was conducted by placebo-controlled double-blind cross-over design, and BPRS (Brief Psychiatric Rating Scale), HDS (Hamilton Depression Scale), and MAS(Mania Scale) were used as rating scales. The results were as follows ; 1) Four of the 24 subjects were regarded as responders. Two of these four showed significant changes both on BPRS and HDS. The other two showed singificant changes in 3 comparisons out of 4 per each subject. In one comparison, the two-tailed P-values of both subjects were 0.0679，which almost reached significant level. 2) Discriminant analysis was done with the present age, age at onset, duration of illness and the baseline scores of BPRS of the responders and the non-responders. Only the combination of 7 items in BPRS was found to be significant(p<C0.00025). Of these 7 items, four were related to the depressive symptom (No 1，5, 9，13), and three were related to the schizophrenic symptom (No. 4, 8, 11). 3) Discriminant function, which could predict Lithium responder and non-responder, was elicited by the combination of above 7 items. Applied to the subjects in this study, the discriminant function classified correctly all the responders and the non-responders. The group centroid of the responders was 4.18174，that of the non-responders was &#4467; 0.83635，and on the discriminant score of 2.2867, the probability of being a responder or a non-responder was the same 50%. 4) There was no irreversible neurotoxicity induced by the combination of Lithium and antipsychotics, especially Haloperidol. With the above results, the authors suggested that although most of schizophrenic patients according to the DSM-III criteria would not respond to the Lithium treatment, some would benefit from it, that the discriminant function might be useful in selection possible Lithium responder, and that within the usual therapeutic blood level of Lithium, the combination of antipsychotics and Lithium could be used even in the schizophrenic patients without the risk of irreversible brain damage.