Korean Journal of Biological Psychiatry

Clozapine, and atypical antipsychotic drug, has been estimated to be a major improvement in the treatment-refractory schizophrenic patients. We evaluated the clozapine efficacy in the treatment of schizophrenic patients who are refractory to classic neuroleptics. The patients were assigned in a prospective, open, comparative trial for 12 weeks. Following on dose titration, 33 inpatients with treatment-refractory schizophrenia diagnosed according to DSM-III-R were given a clozapine(N=17, approximate 300-600mg/day) or haloperidol(N=16, aproximate 20-30mg/day) for 12 weeks. The clinical state was assessed before treatmen, and 1st, 4th, 8th and 12th week during treatment using Bridf Psychiatric Rating Scale(BPRS) and Positive and Negative Syndrome Scale(PANSS). Assessment of side effects were made weekly using simpson-Angus Scale for Estrapyramidal Side Effects and Adverse Events-Somatic Symptoms. Clozapine produces significant improvement than haloperidol on the BPRS and PANSS scores. 77%(13/17) of the clozapine-treated patients were categorized as responders, who showed at least 20% decrease in total BPRS scores, compared with 31%(5/16) of haloperidol-treated patients. Extrapyramidal side effects occurred in only one patient in clozapine group, but nine patients in haloperidol group. Salivation, sleepiness, constipation and hypotension were most frequent adverse effects observed in clozapine group. There was no significant changes in total WBC and neutrophil during clozapine treatment. These findings suggest that clozapine is an effective antipsychotic drug for the Korean treatment-refractory schizophrenic patients, who are nonresponsive to ou unable to tolerate classcal antipsychotic dregdue to estrapyramidal side effects. 

Keywords Clozapine;Refractory Schizophrenia;Therapeutic efficaty;Adverse reactions.