CLOZAPINE TREATMENT FOR NEUROLEPTIC-INDUCED TARDIVE-DYSKINESIA, PARKINSONISM, AND CHRONIC AKATHISIA IN SCHIZOPHRENIC-PATIENTS

Background: Previous studies on the use of clozapine in neuroleptic-re sistant chronic schizophrenic patients have demonstrated positive effe cts on tardive dyskinesia but were less conclusive about chronic akath isia and parkinsonism. The aim of the present study was to investigate the short-term(18 weeks) efficacy of clozapine in neuroleptic-resista nt chronic schizophrenic patients with coexisting tardive dyskinesia, chronic akathisia, and parkinsonism. Method: Twenty chronic, neurolept ic-resistant schizophrenic patients with coexisting tardive dyskinesia , parkinsonism, and chronic akathisia were treated with clozapine. Ass essment of tardive dyskinesia, parkinsonism, and chronic akathisia was made once weekly for 18 weeks with the Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Rating Scale for Extra-pyramidal Side Effe cts, and Barnes Rating Scale for Drug-induced Akathisia (BAS). Results : At the end of 18 weeks of clozapine treatment, improvement rates wer e 74% for tardive dyskinesia, 69% for parkinsonism, and 78% for chroni c akathisia. A statistically significant reduction in the scores on th e AIMS and Simpson-Angus Scale was achieved at Week 5 and on the BAS a t Week 6 (p <.0001). Conclusion: Relatively low doses of clozapine are effective for the treatment of neuroleptic-induced extrapyramidal syn dromes in neuroleptic-resistant chronic schizophrenic patients. The re lief of tardive dyskinesia, parkinsonism, and chronic akathisia in thi s group of patients occurs more rapidly than the reduction in psychoti c symptoms. Disturbing, long-term extrapyramidal syndromes in chronic schizophrenic patients should be considered an indication for clozapin e treatment.