POSITIVE AND NEGATIVE SYMPTOMS COVARY DURING CLOZAPINE TREATMENT IN SCHIZOPHRENIA

Although negative symptoms were traditionally considered to be unrespo nsive to neuroleptic medication, recent studies have demonstrated that negative symptoms do improve during neuroleptic treatment and that su ch improvement tends to occur concurrently with improvement in positiv e symptoms. Clozapine is an atypical neuroleptic that is effective in a significant proportion of otherwise neuroleptic-nonresponsive schizo phrenic patients; in contrast to conventional neuroleptics, clozapine is also purported to possess unique efficacy in the amelioration of ne gative symptoms. How clozapine-associated reduction in negative sympto ms relates to change in positive symptoms is not clear. To study the r elationship between change in positive and negative symptoms during cl ozapine treatment, we monitored symptomatology in 40 DSM-III-R schizop hrenic patients before and about 8 weeks after a trial of clozapine. B oth positive and negative symptoms improved significantly. There was a significant correlation (r = .63, p <.01) between change in positive symptoms and change in negative symptoms; as with conventional neurole ptics, negative symptoms improved concomitantly with positive symptoms during clozapine treatment. Clozapine's apparent greater efficacy on negative symptoms may be related to its greater efficacy on positive s ymptoms in otherwise neuroleptic-refractory patients and its lesser pr opensity to cause extrapyramidal side-effects.