POSITIVE AND NEGATIVE SYMPTOM RESPONSE TO CLOZAPINE IN SCHIZOPHRENIC-PATIENTS WITH AND WITHOUT THE DEFICIT SYNDROME

Objective: In a preliminary report, the authors observed that clozapin e was superior to haloperidol in the treatment of positive and negativ e symptoms in stable outpatients with schizophrenia. In this final rep ort, they examine the effects of clozapine on positive and negative sy mptoms in patients with and without the deficit syndrome to determine which patients receive the positive symptom advantage of clozapine and the extent of clozapine's therapeutic effects on negative symptoms. I n addition, they examine the long-term effects of clozapine on positiv e, negative, and affective symptoms, social and occupational functioni ng, and quality of life. Method: Seventy-five outpatients with schizop hrenia, who met retrospective and prospective criteria for residual po sitive or negative symptoms, were entered into a 10-week double-blind, pal allel-groups comparison of clozapine and haloperidol. Patients wh o completed the double-blind study were then entered into a I-year ope n-label clozapine study. Results: For patients who completed the IO-we ek double-blind study, clozapine was superior to haloperidol in treati ng positive symptoms. This effect was not observed in the intent-to-tr eat analyses. There was no evidence of any superior efficacy or long-t erm effect of clozapine on primary or secondary negative symptoms. Lon g-term clozapine treatment was associated with significant improvement s in social and occupational functioning but not in overall quality of life. Conclusions: For schizophrenic patients who are able to tolerat e clozapine therapy, clozapine has superior efficacy for positive symp toms but not negative symptoms and is associated with long-term improv ements in social and occupational functioning for patients with and wi thout the deficit syndrome.