Ten years' experience with clozapine in treatment-resistant schizophrenic patients: Factors indicating the therapeutic response

SummaryA prospective study in treatment-resistant schizophrenic patients was performed over 10 years to evaluate the therapeutic response to clozapine and the variables related to this treatment. Eighty schizophrenic and schizoaffective patients (according to Diagnostic and Statistical Manual [DSM]-IIIR criteria), considered as refractory (previously resistant to at least two different typical neuroleptics), were studied. The average dose of clozapine was 267 mg/d. The clinical variables considered were: Brief Psychiatric Rating Scale (BPRS), number of admissions before and after clozapine treatment and the Strauss-Carpenter scale as measures of efficacy; Premorbid Adjustment Scale (PAS), to assess personal and social adjustment before illness; Karolinska Personality Scale (KPS) to assess stable traits of personality; and the Simpson-Angus scale as a measure of extrapyramidal symptoms. Sixty percent of patients showed a significant improvement after clozapine treatment. Side-effects were mild and well tolerated, with no cases of haematological disturbance and only five withdrawals because of adverse events. The severity of the episode, according to BPRS score and anxiety as a personal trait, are related to good prognosis. Other relationships between improvement and clinical and demographic variables are discussed.

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

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700002226 ◽

1996 ◽

Vol 13 (1) ◽

pp. 13-18

Author(s):

Isabelle Jalenques ◽

Eliane Albuisson ◽

Igor Tauveron

Keyword(s):

Prospective Study ◽

Negative Symptoms ◽

Rating Scale ◽

Health Care Utilisation ◽

Positive Symptoms ◽

Treatment Resistant ◽

Beneficial Effects ◽

Clozapine Treatment ◽

Schizophrenic Patients ◽

Open Prospective Study

AbstractObjective: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.

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A prospective study of clozapine in treatment-resistant schizophrenic patients

Psychopharmacology ◽

10.1007/bf00442563 ◽

1989 ◽

Vol 99 (S1) ◽

pp. S68-S72 ◽

Cited By ~ 167

Author(s):

H. Y. Meltzer ◽

B. Bastani ◽

K. Young Kwon ◽

L. F. Ramirez ◽

S. Burnett ◽

...

Keyword(s):

Prospective Study ◽

Treatment Resistant ◽

Schizophrenic Patients ◽

A Prospective Study

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A Rating Instrument for the Evaluation of In-Patient Rehabilitation Programmes in China

The British Journal of Psychiatry ◽

10.1192/s0007125000292994 ◽

1994 ◽

Vol 165 (S24) ◽

pp. 58-65 ◽

Cited By ~ 4

Author(s):

Gongan Li ◽

Xiong Hu ◽

Dezhen Jin ◽

Weicai Tian ◽

Michael R. Phillips

Keyword(s):

Rating Scale ◽

Psychiatric Rehabilitation ◽

Correlation Coefficients ◽

Personal Hygiene ◽

Rating Instrument ◽

Before And After ◽

Schizophrenic Patients ◽

Test Retest Reliability ◽

Clinical Measures ◽

Longitudinal Validity

To objectively evaluate in-patient rehabilitation programmes in China, we developed a new rating scale: the Inpatient Psychiatric Rehabilitation Outcome Scale (IPROS). The scale has five subscales: performance in occupational therapy, daily activities, socialisation, personal hygiene, and level of interest in external events. Evaluators (physicians or nurses) observe patients for one week before coding items on a five-point scale. Comparison of four independent evaluators' results for 32 schizophrenic patients assessed on two separate occasions indicated that the inter-rater and test-retest reliability for the overall IPROS score and for the five subscale scores was excellent (all ICC values ≥0.973). Validity was evaluated by comparing IPROS results with those of five other independently assessed clinical measures for 101 chronic schizophrenic patients before and after a six-month rehabilitation programme; concurrent validity and longitudinal validity were satisfactory (correlation coefficients 0.37–0.81, all P values <0.01).

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Cognitive Function Before and After Electroconvulsive Therapy in Patients with Major Depression

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.013 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s241-s242

Author(s):

A. Tmava ◽

I. Eicher ◽

D.E. Seitz ◽

S. Mörkl ◽

C. Blesl ◽

...

Keyword(s):

Cognitive Function ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Verbal Learning ◽

Stroop Test ◽

Trail Making Test ◽

Before And After ◽

Trail Making ◽

Competing Interest ◽

A Prospective Study

BackgroundDespite its high effectiveness, electroconvulsive therapy (ECT) is not a widely used method to treat depression. One of the reasons for this could be the fear of cognitive side effects. The aim of this study was to investigate effects of ECT on cognitive function.MethodsWe conducted a prospective study with a sample size of 23 patients (10 male), who met the criteria of treatment-resistant depression according to ICD–10 and gave their informed consent for ECT treatment. Before and after ECT, the following investigations have been performed: Beck depression inventory (BDI), Montgomery-Asberg depression rating scale (MADRS), Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B), trail making test (TMT) A and B, stroop-test, mini mental state examination (MMSE) and the German version of the California verbal learning test (MGT).ResultsAfter ECT treatment, we found highly significant changes of depression-scales BDI (P = 0.028) and MADR-Scale (P = 0.001). IQ as measured by the MWT-B (P = 0.851), executive functions as measured by trail making test A (P = 0.568) and B (P = 0.372) and stroop-test, memory functions as measured by the MGT (P = 0.565) (Figure 1) and MMSE (P = 0.678) did not differ significantly after ECT treatment.ConclusionThere were no significant differences in cognitive function before and after ECT treatment. To confirm these findings, it would be necessary to perform larger studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clozapine Treatment in Patients with Prior Substance Abuse

The Canadian Journal of Psychiatry ◽

10.1177/070674370304800208 ◽

2003 ◽

Vol 48 (2) ◽

pp. 111-114 ◽

Cited By ~ 16

Author(s):

Deanna L Kelly ◽

Elizabeth A Gale ◽

Robert R Conley

Keyword(s):

Substance Abuse ◽

Rating Scale ◽

Therapeutic Option ◽

Research Unit ◽

Treatment Resistant ◽

Clozapine Treatment ◽

History Of ◽

Psychiatric Rating ◽

Psychiatric Rating Scale ◽

One Year

Objective: This study examined outcomes following discharge on clozapine for treatment-resistant schizophrenia patients with and without diagnosed substance abuse histories. Methods: Those discharged on clozapine from a research unit between April 1991 and March 1996 were followed with respect to hospitalization status. Of the treatment-resistant patients with schizophrenia, 19 were diagnosed as individuals with substance abuse, while 26 patients had no history of abuse. Patients were openly treated with clozapine and were included in the study if they were stabilized and discharged on the medication. Results: Patients who had histories of abuse exhibited a better treatment response and a lower total Brief Psychiatric Rating Scale (BPRS) score at discharge, compared with the non–substance abuse group. One-year readmission rates were 21% and 23% in patients with and without prior substance abuse histories, respectively ( P = ns). Conclusions: Clozapine may be a therapeutic option for the dually diagnosed population and may offer benefits to patients with schizophrenia who have a history of substance abuse.

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Lack of Association between the IL6R Gene Asp358Ala Variant (rs2228145), IL-6 Plasma Levels, and Treatment Resistance in Chilean Schizophrenic Patients Treated with Clozapine

Schizophrenia Research and Treatment ◽

10.1155/2019/5601249 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Alvaro Cavieres ◽

Carolina Campos-Estrada ◽

Yanneth Moya ◽

Rocío Maldonado ◽

René González-Vargas ◽

...

Keyword(s):

Plasma Levels ◽

Rating Scale ◽

Receptor Gene ◽

Treatment Resistance ◽

Response To Treatment ◽

Clozapine Treatment ◽

Interesting Candidate ◽

Schizophrenic Patients ◽

Inflammatory System

Alterations in neuroinflammatory processes have been suggested to contribute to the development of Schizophrenia (SZ); one component of the inflammatory system that has been linked to this disorder is interleukin-6 (IL-6). The minor allele of rs2228145, a functional polymorphism in the IL-6 receptor gene, has been associated to elevated IL-6 plasma levels and increased inflammatory activity, making it an interesting candidate to study as a possible factor underlying clinical heterogeneity in SZ. We studied a sample of 100 patients undergoing treatment with clozapine. Their symptoms were quantified by Brief Psychotic Rating Scale; those with the lowest scores (“remitted”) were compared with the highest (“clozapine treatment resistant”). We determined allelic frequencies for rs2228145 and IL-6 plasma levels. Our results do not support a role of IL-6 in response to treatment with clozapine. Further studies accounting for potential confounding factors are necessary.

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Idazoxan and Response to Typical Neuroleptics in Treatment-Resistant Schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.168.5.571 ◽

1996 ◽

Vol 168 (5) ◽

pp. 571-579 ◽

Cited By ~ 82

Author(s):

Robert E. Litman ◽

Tung-Ping Su ◽

William Z. Potter ◽

Walter W. Hong ◽

David Pickar

Keyword(s):

Negative Symptoms ◽

Rating Scale ◽

Random Order ◽

Symptom Improvement ◽

Treatment Resistant ◽

Neuroleptic Treatment ◽

Double Blind ◽

Clozapine Treatment ◽

Psychiatric Rating Scale ◽

Typical Neuroleptics

BackgroundWe investigated whether antagonism of α2adrenergic receptors would augment treatment response in schizophrenia, by administering idazoxan, an α2antagonist drug, to treatment-resistant patients on typical neuroleptics.MethodSeventeen hospitalised treatment-resistant patients with DSM–III–R schizophrenia or schizoaffective disorder were studied on typical neuroleptic treatment, on treatment with idazoxan plus typical neuroleptic, and after discontinuation of idazoxan, in fixed, non-random order, and under double-blind, placebo-controlled conditions.ResultsThe addition of idazoxan to fluphenazine treatment resulted in significant reductions of global psychosis and total, positive and negative symptoms on the Brief Psychiatric Rating Scale, compared to neuroleptic treatment alone. Symptom improvement significantly correlated with idazoxan-induced changes in indices of noradrenergic function. In a subgroup of patients, idazoxan plus typical neuroleptic treatment compared favourably with clozapine treatment, when both were compared to typical neuroleptic treatment alone.ConclusionsThe antagonism of α2receptors augmented therapeutic response to typical neuroleptic treatment in treatment-resistant patients with schizophrenia. This antagonism may contribute to clozapine's superior antipsychotic effects.

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Pengaruh Terapi Psikoreligious: Dzikir dalam Mengontrol Halusinasi Pendengaran Pada Pasien Skizofrenia yang Muslim di Rumah Sakit Jiwa Tampan Provinsi Riau

Jurnal Ilmiah Universitas Batanghari Jambi ◽

10.33087/jiubj.v20i3.1063 ◽

2020 ◽

Vol 20 (3) ◽

pp. 821

Author(s):

Pratiwi Gasril ◽

Suryani Suryani ◽

Heppi Sasmita

Keyword(s):

Rating Scale ◽

American Psychological Association ◽

Auditory Hallucinations ◽

P Value ◽

World Population ◽

American Psychological ◽

Before And After ◽

Schizophrenic Patients ◽

Patients Experience ◽

Additional Therapy

Data from the American Psychological Association (APA) in 2010 and Riskesdas 2013 show that on the average world population has schizophrenia and 70% of schizophrenic patients experience hallucinations. One of the recommended therapies in an effort to control hallucinations is psychoreligious therapy: dhikr. The purpose of this study was to determine the effect of psycho-religious therapy: dhikr in controlling hallucinations in schizophrenia patients. The research method used is quantitative with a Quasy expriemental approach carried out on 20 respondents at the Tampan Mental Hospital, Riau Province. Researchers used the Auditory Hallucinations Rating Scale (AHRS) module and evaluation sheet before and after the intervention. The results showed that there was an effect of psychoreligious therapy: dhikr in controlling hallucinations in schizophrenic patients (p value = 0,000). The results of this study can be used as additional therapy in controlling hallucinations in patients with auditory hallucinations.

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The Therapeutic Effect of Edible Horticultural Therapy on Extrapyramidal Symptoms in Patients with Schizophrenia

HortScience ◽

10.21273/hortsci15916-21 ◽

2021 ◽

pp. 1-5

Author(s):

Hui He ◽

Tingting Li ◽

Fan Zhou ◽

Qianjun Yang ◽

Luyun Hu ◽

...

Keyword(s):

Adverse Reactions ◽

Rating Scale ◽

Psychiatric Patients ◽

Extrapyramidal Symptoms ◽

Control Group ◽

Horticultural Therapy ◽

Psychopathological Symptoms ◽

Before And After ◽

Schizophrenic Patients ◽

New Evidence

Extrapyramidal symptoms (EPSs) are common adverse reactions to antipsychotics in patients with schizophrenia. The purpose of this study was to investigate the effects of edible horticultural therapy (EHT) on EPSs in schizophrenic patients. This study assessed the changes in psychopathological symptoms and extrapyramidal symptoms in patients with schizophrenia before and after participating in a six-session EHT. Forty schizophrenic patients, recruited from Wuhan Wudong Hospital, were randomly assigned to the EHT group (average age: 45.40 ± 13.960 years) or the control group (average age: 49.30 ± 12.516 years). The EHT program held weekly sessions from May 2020 to June 2020. A psychiatrist assessed the psychopathological symptoms and extrapyramidal symptoms of schizophrenic patients in both groups with the Chinese version of the Positive and Negative Syndromes Scale (PANSS) and the Rating Scale for Extrapyramidal Side Effects (RSESE). After six courses of horticultural therapy, the terms of positive, negative, and general symptoms on the PANSS significantly improved in the EHT group. Moreover, the EPSs were also significantly improved in the EHT group. However, there was no change in the PANSS and RSESE scores in the control group. This study shows that EHT has the potential to improve not only psychopathological symptoms but also EPSs in psychiatric patients. This adds new evidence for EHT as an adjunct to treatment for schizophrenia.

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