Clozapine 急性中毒引起抗精神病藥物惡性症候?：一例報告

　　　　　目的：Clozapine一直被認為不易造成錐體外症候群及抗精神病藥物惡性症候群 (NNS)，在國內也未曾發表過相關報告，此個案報告在說clozapine急性中毒後亦可引起抗精 神病藥物惡性症候群。病例報告：一位精神分裂病人，先前並未出現過NMS，在clozapine 中毒24小時後產生無肌肉僵直的非典型抗精神病藥物惡性症候群(atypical NMS)，文中並討 論NMS診斷準則、機轉、及大量肌酸磷酸□(CPK)升高的可能原因。結論：藉此死亡病例 報告提醒臨床醫師，clozapine還是有可能引起NMS及非典型NMS，故應小心鑑別診斷。 因外，本個案也提醒我們特別注意，在抗精神病劑急性中毒之後，仍有可能發生NMS的情 形。
　　　　　Objective: Clozapine, a tricyclic dibenzo-diazepine, is an atypical antipsychotic agent that was initially thought to be less likely to induce extrapyramidal side effects and neuroleptic malignant syndrome (NMS) than typical antipsychotic agents. Here, we report a case of atypical NMS caused by acut clozapine intoxication. Case Report: A 21 year-old woman who suffered from schizophrenia for four years with prior history of NMS was brought to our hospital emergency room following the ingestion of about 3,000 mg of clozapine. One day later, a complex of symptoms including hyperthemia, conscious disturbance, autonomic dysfunction, leukocytosis, elecated CPK, LDH, and urine myoglobin developed. Although no muscle rigidity was noted, atypical NMS was diagnosed. Despite supportive treament for thirteen days, the patient died of respiratory failure and rhabdomyolysis. Conclusion: The present case may serve to alert clinicians that NMS or atypital NMS may occur in patients with clozapine intoxication. (Full Text in Chinese)