CLOZAPINE VERSUS TYPICAL ANTIPSYCHOTICS - A RETROSPECTIVE-STUDY AND PROSPECTIVE-STUDY OF EXTRAPYRAMIDAL SIDE-EFFECTS

Schizophrenic patients in long-term neuroleptic monotherapy with cloza pine (n = 100) and perphenazine. flupenthixol or zuclopentixol (contro ls, n = 100) were evaluated for extrapyramidal side effects (EPS) (bli nd) as well as other side effects and mental condition (non-blind). In both groups the patients hud received neuroleptic treatment for a tot al of 14 years (median) and the present antipsychotic (clozapine or co ntrol drug) for 5 years. Thus the clozapine-treated patients had previ ously received traditional neuroleptics for 9 years (median). The stud y was both retrospective (0.3-19 years for clozapine, 0.3-24 years for control drug, by means of chart information) and prospective (1 year, with video-controlled evaluation of EPS. There was a significantly lo wer prevalence of tardive dyskinesia (TD) in clozapine treated patient s than control patients, although prior to this treatment there were m ore TD patients in the clozapine group (P < 0.05). This lower level of TD in the clozapine group was related to a lower induction of new cas es (P < 0.001) and a tendency towards greater disappearance of TD in t he clozapine than in the control group (P = 0.07). Clozapine treated p atients without TD had started clozapine and ceased traditional neurol eptics at an earlier age than those with TD. Parkinsonian signs were s een in 33% of the clozapine patients versus 61% of the control patient s, mainly as hypokinesia; tremor in 3% versus 11% and rigidity in 0 ve rsus 19%. Psychic akathisia was found in 14% versus 40% and motor akat hisia in 7% versus 29% of the patients, all differences significantly in favor of clozapine. Clozapine treated patients also had less neurol eptic-induced emotional indifference and depression, but more autonomi c side effects than controls.