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The effects of clozapine on symptom clusters in older “treatment-refractory” patients
Abstract   Peer reviewed

The effects of clozapine on symptom clusters in older “treatment-refractory” patients

G. Abraham, J.I. Tracy, C. Nair, R.C. Josiassen and G. Simpson
Biological psychiatry (1969), v 39(7), pp 543-543
Apr 1996

Abstract

Preliminary results of a double-blind clozapine study. in an older population of chronic schizophrenic patients at a state psychiatric facility, are reported. Thirty DSM-III-R diagnosed "treatment-refractory" schizophrenics, with a mean age of 44±9.1 years and a duration of illness of 24.9±:8.8 years, randomized to 300 mg or 600 mg of clozapine were analyzed. Subjects were evaluated using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI) Scale on a weekly basis for sixteen weeks. Based on their CGI scores at week sixteen of clozapine treatment, the subjects were retrospectively categorized as "improvers" and "non-improvers". Twelve of 30 subjects (40%) were found to be "improvers". When Kane et al, criteria for defining "responders" was applied. only three of thirty subjects (10%) met "responder" criteria, Comparison of the mean total BPRS scores at baseline with subsequent clozapine weeks in "improvers'" showed a significant decrease by 6th week of clozapine. On analyzing the four BPRS factors. the "improvers" showed a reliable decrease. i.e. improvement. in Thinking Disturbance by week 1 that remained steady from week 7. On Hostility-Suspiciousness factor, the pattern of response for "improvers" and "non-improvers" differed across time. Withdrawal·-Retardation factor also showed improvement, while Anxiety-Depression factor was least influenced by clozapine. This study highlights the varied impact of a different criteria, which showed that categorizing older chronic schizophrenic patients by less stringent criteria was helpful in detecting clozapine's effect on specific symptom clusters.

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