PATIENT RESPONSE AND RESOURCE-MANAGEMENT - ANOTHER VIEW OF CLOZAPINE TREATMENT OF SCHIZOPHRENIA

Objective: Issues in clozapine treatment were considered in terms of i mplications for resource management. Method: A critical review of the literature on time course and pattern of response to clozapine was use d to address treatment of negative symptoms, late responders, and exte nt of clinical benefit in ordinary settings. Results: Superior efficac y of clozapine for partial and poor neuroleptic responders is observed in about one-half of the cases. Response is rapid once a therapeutic dose is reached, and the data do not support the proposition that some patients first respond only after 3-12 months of therapy. The cumulat ive benefit over several months of treatment and the broad range of sy mptoms involved in response are similar to those for typical neurolept ic drugs, suggesting that clozapine's superiority is based on greater effectiveness rather than a unique profile of treatment effects. Cloza pine appears to be effective for secondary, but not primary, negative symptoms. Modal response is moderate, and extensive rehabilitation and clinical services are required to substantially enhance functional ou tcome. Conclusions: Many more patients merit trials with clozapine. Ec onomic costs and adverse drug effects cart be minimized by selecting p atients most likely to benefit and discontinuing clozapine treatment w hen benefit is not observed within 2-4 months. Appropriate patients in clude 1) those with good responses to typical neuroleptics who experie nce substantial adverse effects and 2) those whose disorders respond p oorly to standard neuroleptics and are defined by psychotic symptoms, thought disorder, and hostility. Treatment of primary negative symptom s is not supported by the current experimental data.