Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T22:56:25.465Z Has data issue: false hasContentIssue false
  • English
  • Français

Clozapine in treatment-resistant schizophrenic patients: preliminary results from an open prospective study

Published online by Cambridge University Press:  13 June 2014

Isabelle Jalenques ,
Eliane Albuisson  and
Igor Tauveron
Isabelle Jalenques
Affiliation:
Service de Psychiatrie A, Centre Médico Psychologique
Eliane Albuisson
Affiliation:
Service de Biostatisques
Igor Tauveron
Affiliation:
Service de Médecine, CHU Saint-Jacques BP 69, 63003 Clermont-Ferrand, Cedex, France
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This report describes an open prospective study of the effects of clozapine on positive and negative symptomatology in treatment resistant schizophrenic patients.

Method: In this prospective study, 15 DSM-III-R schizophrenic patients, who had failed to respond to various neuroleptics were followed up for a period of 21 months (median: 9; 25th and 75th percentiles: 4-10). When clozapine treatment was initiated, the mean duration of the illness was 16 +/-9 years. Brief Psychiatric Rating Scale (BPRS) scores, BPRS ‘positive symptoms’ and BPRS ‘anergia factor’ scores were all rated at days 0 and 15, months one, two and three and every three months thereafter.

Results: Significant improvements in total BPRS scores, BPRS positive symptoms and anergia factor were recorded and resulted in two distinct patterns of outcome. The improvements in BPRS scores translated into marked changes in health care utilisation and in sheltered employment. Of the side effects noted, dry mouth was more common in the first month after wash-out (three patients), while hypersalivation was more frequent after this period (eight patients). There was no agranulocytosis in this cohort. Two cases of eosinophilla occurred during the first month. Weight gain affected six patients.

Conclusions: We found that clozapine offers particular benefits for some treatment-resistant schizophrenic patients despite the increased hematologic risk. Our study also indicates that the beneficial effects of clozapine are delayed in relation to negative symptoms as compared with positive symptoms.

Keywords

ClozapineSchizophreniaPositive symptomsNegative symptoms
Type
Brief Reports
Information
Irish Journal of Psychological Medicine , Volume 13 , Issue 1 , March 1996 , pp. 13 - 18
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kane, J, Honigfeld, G, Singer, J, Meltzer, H. Clozapine for the treatment-resistant schizophrenic. Arch Gen Psychiatr 1988; 45: 789–96.CrossRefGoogle ScholarPubMed
2.Gverall, JE, Gorham, DR. The Brief Psychiatric Rating Scale. Psychol Rep 1962; 10: 799–812.Google Scholar
3.Juul-Povlsen, VJ, Noring, U, Fog, R, Gerlach, J. Tolerability and therapeutic effect of clozapine: a retrospective investigation of 216 patients treated with clozapine for up to 12 years. Acta Psychiatr Scand 1985; 71: 176–85.CrossRefGoogle ScholarPubMed
4.Kuha, S, Miettinen, E. Long-term effect of clozapine in schizophrenia: a retrospective study of 108 chronic schizophrenics treated with clozapine for up to 7 years. Nord Psyk Tidsskrift 1986; 40: 225–30.CrossRefGoogle Scholar
5.Lindstrom, LH. The effect of long term treatment with clozapine in schizophrenia: a retrospective study in 96 patients treated with clozapine for up to 13 years. Acta Psychiatr Scand 1988; 77: 524–9CrossRefGoogle ScholarPubMed
6.Leppig, M, Bosch, B, Naber, D, Hippius, H. Clozapine in the treatment of 121 outatients. Psychopharmacol 1989; 99: S77–S79CrossRefGoogle Scholar
7.Naber, D, Leppig, M, Hippius, H. Long term treatment with clozapine: efficiency, side effects and tolerability. Symposium on the use of clozapine in treatment resistant schizophrenia. Proceedings of the 8th World Congress of Psychiatry. Athens. 13-19 October 1989, 13–17.Google Scholar
8.Meltzer, HY, Bastani, B, Kwon, KY, Ramirez, LF, Burnett, S, Sharpe, J. A prospective study of clozapine in treatmentresistant schizophrenic patients: I. Preliminary report. Psychopharmacol 1989; 99: S68–S72.CrossRefGoogle ScholarPubMed
9.Krupp, P, Barnes, P. Leponex associated granulocytopenia: a review of the situation. Psychopharmacol 1989; 99: S118–S121.CrossRefGoogle ScholarPubMed
10.May, PRA, Dencker, SJ, Hubbard, JW, Midha, KK, Libenman, RP. A systematic approach to treatment resistance in schizophrenic disorder. In: Dencker, SJ, Kulhanerk, F, editors. Treatment resistance in schizophrenia. Vieweg & Sohn Verlgsgesellschaft mbh: Braunschweig, 1988: 22–33.Google Scholar
11.Owen, RR, Beake, BJ, Marby, D, Dessain, EC. Response to clozapine in chronic psychotic patients. Psychopharmacol Bull 1989; 25: 253–6.Google ScholarPubMed
12.Breier, A, Buchanan, RW, Kirkpatrick, B, Davis, OR, Irish, D, Summerfelt, A, Carpenter, WT. Effects of clozapine on positive and negative symptoms in outpatients with schizophrenia. Am J Psychiatry 1994; 151: 1, 20–25.Google ScholarPubMed
13.Watt, DC, Szulecka, TK. The effect of sex, marriage and age at first admission of the hospitalisation of schizophrenics during 2 years following discharge. Psychol Med 1979; 9: 529–39CrossRefGoogle ScholarPubMed
14.Seeman, MV. Gender differences in schizophrenia. Can J Psychiatr 1982; 27: 107–12CrossRefGoogle ScholarPubMed
15.Salokangas, RKR. Prognostic implications of the sex of schizophrenic patients. Brit J Psychiat 1983; 142: 145–51CrossRefGoogle ScholarPubMed
16.Angermeyer, MC, Goldstein, JM, Kuehn, L. Gender differences in schizophrenia: rehospitalization and community survival. Psychol Med 1989; 19: 365–82.CrossRefGoogle ScholarPubMed
17.Breier, A, Schreiber, JL, Dyer, J, Pickar, D. National institute of mental health longitudinal study of chronic schizophrenia. Arch Gen Psychiatry 1991; 48: 239–46.CrossRefGoogle ScholarPubMed
18.Carone, BJ, Harrow, M, Westenmeyer, JF. Posthospital course and outcome in schizophrenia. Arch Gen Psychiatry 1991; 48: 247–53.CrossRefGoogle ScholarPubMed
19.Pickar, D, Owen, RR, Litman, RE, Konicki, E, Gutierrez, R, Rapaport, MH. Clinical and biologic response to clozapine in patients with schizophrenia: crossover comparison with fluphenazine. Arch Gen Psychiatry 1992; 49: 345–53.CrossRefGoogle ScholarPubMed
20.Meltzer, HY, Bernett, S, Bastanni, B, Ramirez, LF. Effects of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychiatry 1990; 41: 892–7.Google ScholarPubMed
21.Davies, M, Conley, RR, Schulz, SC, Bell-Delaney, J. One-year follow-up of 24 patients in a clinical trial of clozapine. Hosp Community Psychiatry 1991; 42: 628–9.Google Scholar
22.Wilson, WH. Clinical review of clozapine treatment in a state hospital. Hosp Community Psychiatry 1992; 43: 700–3.Google ScholarPubMed
23.Christison, GW, Kirch, DG, Wyatt, RJ. When symptoms persist: choosing among alternatives somatic treatments for schizophrenia. Schizophren Bull 1991; 17: 217–46.CrossRefGoogle ScholarPubMed
24.Kane, JM. Treatment duration of psychiatric disorder: long-tenm treatment of resistant schizophrenia. Eur Psychiatry 1993; 8: 281–3.CrossRefGoogle Scholar
25.Tandon, R, Ribeiro, SCM, Perez, M, Goodson, J, Greden, JF. Positive and negative symptoms in schizophrenia covary during treatment with typical neuroleptics and clozapine. Schizophr Research 1994; 11, (Spec Issue): 117–8 (abs IIIC. Poster 60).Google Scholar
26.Meltzer, HY, Cola, Way L, Thompson, PA, Bastani, B, Davies, A, Snitz, B. Cost effectiveness of clozapine in neurolepticresistant schizophrenia. Am J Psychiatry 1993; 150: 11, 1630–8.Google ScholarPubMed
27.Fitton, A, Heel, RC. Clozapine: a review of its phanacological properties, and therapeutic use in schizophrenia. Drugs 40 1990; 5: 722–47.CrossRefGoogle Scholar
28.Tandon, R, Shipley, JE, Taylor, SF, Goodson, J, Perez, M, Eiser, A, Greden, JF. Effects of clozapine on polysomnographic measures in schizophrenia. Schizophr Research 1994; 11 (Spec Issue): 117–118 (abs IIIC Poster 59).Google Scholar
29.Alvir, JMJ, Liebenman, JA, Safferman, AZ, Schwimmer, JL, Schaaf, JA. Clozapine-induced agranulocytosis. N Engl J Med 1993; 15: 162–7.CrossRefGoogle Scholar