The Safety and Efficacy of Clozapine in Severe Treatment-Resistant Schizophrenic Patients in the UK

1993 ◽  
Vol 163 (2) ◽  
pp. 150-154 ◽  
Author(s):  
C. E. Adams ◽  
T. R. E. Barnes ◽  
M. A. Essali ◽  
S. R. Hirsch ◽  
A. V. P. MacKay ◽  
...  
Keyword(s):  
Adverse Event ◽  
Side Effects ◽  
Negative Symptoms ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Frequent Adverse Event ◽  
Safety And Efficacy ◽  
Schizophrenic Patients ◽  
The Uk ◽  
Positive And Negative Symptoms

In order to assess the safety and some efficacy aspects of clozapine under UK conditions, 54 in-patients with severe treatment-resistant schizophrenic disorders were evaluated using several scales before and during treatment. Of the 54 evaluated, 26 completed the 26-week study. Of these patients, 20 showed improvement in psychopathology, often to a marked degree, involving both positive and negative symptoms. Some oral-facial extrapyramidal side-effects decreased as well. Two patients developed neutropenia, but recovered on discontinuation of clozapine. The most frequent adverse event was hypersalivation, and five patients suffered from seizures. It is concluded that clozapine is worth considering for the treatment of severe treatment-resistant patients in the UK.

Receptor mechanisms of antipsychotic drug atypicality

1998 ◽  
Vol 13 (S1) ◽  
pp. 5s-8s
Author(s):  
GP Reynolds
Keyword(s):  
Side Effects ◽  
Animal Models ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Mechanisms Of Action ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Pharmacological Profile ◽  
New Compounds

SummaryRecent advances in antipsychotic treatment of schizophrenia have offered several new compounds which avoid many of the limitations of the classical antipsychotics. These so-called ‘atypical’ antipsychotics have fewer extrapyramidal side effects, greater efficacy against negative symptoms and greater efficacy in otherwise treatment-resistant patients. However, the mechanism of action of these atypical antipsychotics is still unclear. The several receptors currently implicated in the pharmacological profile of these atypical antipsychotics include subtypes of those for dopamine, serotonin, noradrenaline, and acetylcholine among others. The current hypotheses for possible mechanisms of action of atypical antipsychotics are discussed along with the experimental correlates of antipsychotic efficacy in animal models.

Sulpiride: an advance in neuroleptics?

1984 ◽  
Vol 22 (8) ◽  
pp. 31-32
Keyword(s):  
Side Effects ◽  
Social Withdrawal ◽  
Extrapyramidal Side Effects ◽  
Schizophrenic Patients ◽  
Substituted Benzamide ◽  
The Uk

Sulpiride (Dolmatil - Squibb) is a substituted benzamide related to metoclopramide. It has only recently been marketed in the UK, but has been used in Europe for many years. The manufacturer claims that the drug has both antidepressive and neuroleptic properties, and that it is of particular benefit for schizophrenic patients who develop social withdrawal. Extrapyramidal side effects are claimed to be less than with conventional neuroleptics.

scholarly journals Clozapine-induced intestinal obstruction - a critical examination of four cases

2006 ◽  
Vol 12 (1) ◽  
pp. 4
Author(s):  
C Seller ◽  
L Koen ◽  
D J H Niehaus
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Critical Examination ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects ◽  
Atypical Antipsychotic Drug ◽  
Superior Efficacy ◽  
Added Benefit ◽  
Treatment Refractory ◽  
Positive And Negative Symptoms

Clozapine is an atypical antipsychotic drug indicated for the management of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. It has demonstrated superior efficacy in treating both the positive and negative symptoms in treatment-refractory cases. It also has the added benefit of causing minimal extrapyramidal side- effects, producing no tardive dyskinesia and having little effect on prolactin levels

Relationship between Neuroleptic Dose and Positive and Negative Symptoms

1994 ◽  
Vol 74 (2) ◽  
pp. 481-482 ◽  
Author(s):  
Patrick B. Johnson ◽  
Lewis A. Opler ◽  
Paul M. Ramirez ◽  
Robert Malgady
Keyword(s):  
Side Effects ◽  
Negative Symptom ◽  
Negative Symptoms ◽  
Zero Order ◽  
Standardized Assessments ◽  
Symptom Scores ◽  
Medication Dose ◽  
Schizophrenic Patients ◽  
Positive And Negative Symptoms

The present study explored possible connections between neuroleptic dose and the positive and negative symptoms of schizophrenic patients. Zero-order correlations between medication dose as measured in CPZ equivalent units and standardized assessments of positive (hallucinations, delusions) and negative (blunted affect, poor rapport) symptoms were carried out on 28 hospitalized schizophrenics. While dose was positively related to over-all negative symptom scores as well as specific negative symptoms, no relation was found with positive scores. The discussion focused on the possibility that negative symptoms might represent medication-induced side effects and the need for further research.

Efficacy of clozapine in treatment-resistant psychosis and neuroleptic sensitivity: results of the Dutch open multi-center project

1992 ◽  
Vol 7 (2) ◽  
pp. 77-84 ◽  
Author(s):  
WMA Verhoeven ◽  
WH Doesburg ◽  
R Snoej ◽  
AJMP Rutgers ◽  
PHM van Dongen
Keyword(s):  
Side Effects ◽  
Marked Reduction ◽  
Antipsychotic Agent ◽  
Percentage Reduction ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Schizophrenic Patients ◽  
Multi Center Study ◽  
Center Study

SummaryIn an open multi-center study, 57 schizophrenic patients were treated with clozapine for indications of treatment-resistant psychosis or severe extrapyramidal side-effects caused by conventional neuroleptics. In 58% of the patients a clinical relevant improvement, expressed as percentage reduction of at least 50 from baseline BPRS scores was observed. With respect to extrapyramidal side-effects, a marked reduction was found upon treatment with clozapine. No major side-effects occurred, particularly agranulocytosis. It was concluded that clozapine is a potent antipsychotic agent that can be used safely when treatment is accompanied by frequent clinical and hematological monitoring.

Recent antipsychotics in the treatment of psychoses

1999 ◽  
Vol 11 (3) ◽  
pp. 85-92
Author(s):  
M.J.A.J.M. Hoes
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Clinical Problem ◽  
New Drugs ◽  
Clinical Aspects ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Short And Long Term ◽  
High Doses

SummaryAntipsychotic drugs are effective in psychoses, whatever the etiology of the disorder. The positive symptoms tend to respond more readily. The need for developing new drugs arises from the refractoriness of the negative symptoms, the 10-25% of the patients that are treatment-resistant and the problems of short-, and long-term extrapyramidal side-effects. Thus far, six drugs, differing from the classical antipsychotics, have been licensedfor use: olanzepine, risperidone and quetiapine; the longest registration exists for sulpiride and clozapine while the most recent one is for amisulpride. This review starts with a brief introduction to symptomatology, and takes differences with the classical drugs in pharmacology, pharmacokinetics, clinical aspects and side-effects into consideration. Clozapine, risperidone and sulpiride may be considered for clinical use in refractory patients; these three, olanzapine and amisulpride when extrapyramidal side-effects cause a clinical problem. Amisulpride and sulpiride have a dual therapeutic acion: On negative symptoms at low dose, on positive symptomen at high doses.

Sulpiride adjunction to clozapine in treatment-resistant schizophrenic patients: a preliminary case series study

1997 ◽  
Vol 12 (3) ◽  
pp. 152-155 ◽  
Author(s):  
R Shiloh ◽  
Z Zemishlany ◽  
D Aizenberg ◽  
A Weizman
Keyword(s):  
Negative Symptoms ◽  
Case Series ◽  
Treatment Resistant ◽  
Case Series Study ◽  
Schizophrenic Patients ◽  
Chronic Neuroleptic ◽  
Series Study ◽  
Remarkable Reduction ◽  
Positive And Negative Symptoms

SummarySix chronic neuroleptic-resistant schizophrenic patients, partial responders to clozapine, were co-administered 600 mg/day of sulpiride (a selective D2 dopaminergic antagonist) as an augmentation to clozapine (a relatively weak D2 blocker), for 10 weeks, open-labeled. A remarkable reduction in positive and negative symptoms was observed in four of the six patients.

Dose reduction of risperidone and olanzapine can improve cognitive function and negative symptoms in stable schizophrenic patients: A single-blinded, 52-week, randomized controlled study

2018 ◽  
Vol 32 (5) ◽  
pp. 524-532 ◽  
Author(s):  
Yanling Zhou ◽  
Guannan Li ◽  
Dan Li ◽  
Hongmei Cui ◽  
Yuping Ning
Keyword(s):  
Side Effects ◽  
Dose Reduction ◽  
Negative Symptom ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Symptom Assessment ◽  
Extrapyramidal Side Effects ◽  
Syndrome Scale ◽  
Schizophrenic Patients ◽  
Negative Syndrome

Background: The long-term effects of dose reduction of atypical antipsychotics on cognitive function and symptomatology in stable patients with schizophrenia remain unclear. We sought to determine the change in cognitive function and symptomatology after reducing risperidone or olanzapine dosage in stable schizophrenic patients. Methods: Seventy-five stabilized schizophrenic patients prescribed risperidone (≥4 mg/day) or olanzapine (≥10 mg/day) were randomly divided into a dose-reduction group ( n=37) and a maintenance group ( n=38). For the dose-reduction group, the dose of antipsychotics was reduced by 50%; for the maintenance group, the dose remained unchanged throughout the whole study. The Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery were measured at baseline, 12, 28, and 52 weeks. Linear mixed models were performed to compare the Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects and MATRICS Consensus Cognitive Battery scores between groups. Results: The linear mixed model showed significant time by group interactions on the Positive and Negative Syndrome Scale negative symptoms, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, attention/vigilance, working memory and total score of MATRICS Consensus Cognitive Battery (all p<0.05). Post hoc analyses showed significant improvement in Positive and Negative Syndrome Scale negative subscale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, working memory and total score of MATRICS Consensus Cognitive Battery for the dose reduction group compared with those for the maintenance group (all p<0.05). Conclusions: This study indicated that a risperidone or olanzapine dose reduction of 50% may not lead to more severe symptomatology but can improve speed of processing, working memory and negative symptoms in patients with stabilized schizophrenia.

Treatment of Aggressive Behavior in Dementia With the Anticonvulsant Topiramate: A Retrospective Pilot Study

2003 ◽  
Vol 15 (3) ◽  
pp. 307-309 ◽  
Author(s):  
Benny Fhager ◽  
Inga-Maj Meiri ◽  
Magnus Sjögren ◽  
Åke Edman
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Side Effects ◽  
Aggressive Behavior ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Careful Treatment ◽  
And Training ◽  
Low Dosage

Aggressive behavior in dementia often has a severe impact on the quality of life of the patient and the caregivers, and is therefore important to handle. The strategy of treatment should be broad. Nonpharmacological interventions, including environmental adjustments and supporting and training the caregivers, should always be considered. Pharmacological treatment of aggressive behavior in patients with dementia often includes the use of neuroleptics. The atypical compounds clozapine, risperidone, and olanzapine have been shown to have an effect on aggressive behavior at low dosage with limited extrapyramidal side effects. The anticonvulsants carbamazepine and sodium valproate are further alternatives. In treatment-resistant cases, buspirone or lithium may be tried, although the effect of these substances on aggressive behavior in dementia has not been well established. In the end, however, a considerable degree of aggressive behavior sometimes remains after careful treatment trials, particularly in patients with severe aggressive behavior. In addition, treatment is sometimes limited by side effects.

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