THE EFFECTS OF CLOZAPINE ON SYMPTOM CLUSTERS IN TREATMENT-REFRACTORY PATIENTS

Preliminary results of a double-blind clozapine study in a population of chronic psychotic patients at a state psychiatric facility are repo rted. Thirty ''treatment-refractory'' schizophrenic patients given a d iagnosis according to DSM-III-R criteria (mean age of 44 +/- 9.1 years and a duration of illness of 24.9 +/- 8.8 years) who received 300 mg or 600 mg of clozapine and randomized in a double-blind fashion were a nalyzed. Subjects were evaluated using the Brief Psychiatric Rating Sc ale (BPRS) and the Clinical Global Impression (CGI) Scale on a weekly basis for 16 weeks. Based on the changes in their CGI scores at week 1 6 of clozapine treatment, subjects were retrospectively categorized as ''improvers'' (N = 12) and ''nonimprovers'' (N = 18). The two groups were compared for changes in total BPRS and BPRS factor scores. In ter ms of total BPRS scores, we expected a, difference between the two gro ups because they were categorized based on changes in their CGI scores . However, the total BPRS scores in improvers showed a significant dec rease by week 6 of clozapine treatment. On analyzing the four BPRS fac tors, the improvers showed improvement in the thinking disturbance fac tor by week 1 that remained steady from week 7. On the hostility-suspi ciousness factor, the improvers showed an improvement across time when compared with nonimprovers. The withdrawal-retardation factor showed improvement in both groups across time, whereas the anxiety-depression factor was least influenced by clozapine. These observations suggeste d that all BPRS symptom factors did not uniformly contribute to improv ement in overall psychopathology, which was observed as a decrease in total BPRS scores.