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Multiple-outcome criteria in schizophrenia: an overview of outcome with clozapine

Published online by Cambridge University Press:  16 April 2020

HY Meltzer
HY Meltzer*
Affiliation:
Laboratory of Biological Psychiatry, Department of Psychiatry Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, Ohio 44106-5078, USA
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Summary

The outcome of treatment in schizophrenia is best considered as a multidimensional construct. This report lists thirteen categories of outcome measures that have been studied in schizophrenia research, among the most important of which are psychopathology, cognitive function, interpersonal social function, quality of life, extrapyramidal function, the suicide tendeccy and the need for hospitalisation. Clozapine is effective in achieving improved outcome in all these measures in a high percentage of neuroleptic-resistant patients. Ninety-two of 180 (51.1%) clozapine-treated neuroleptic-resistant patients achieved a decrease of 20% in Brief Psychiatric Rating Scale total scores at six weeks using the 0–6 scaling system. Cognitive function contributes importantly to overall function for schizophrenia. Clozapine has been shown to improve some types of cognition in schizophrenia, especially semantic memory and some tests of executive function. Clozapine has also been shown to decrease the incidence of suicide and hospitalisation. The task of deciding which therapies to use in schizophrenia should encompass the spectrum of benefits of each therapy, their risks and costs, in relation to all alternatives.

Keywords

schizophreniaoutcomeneurolepticquality of lifeclozapine
Type
Research Article
Information
European Psychiatry , Volume 10 , Issue S1 , 1995 , pp. 19s - 25s
Copyright
Copyright © Elsevier, Paris 1995

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References

Alvir, JMJLieberman, JASafferman, AZet al.Clozapine-induced agranulocytosis incidence and risk factors in the United States N Engl J Med 329 1993 162–7CrossRefGoogle ScholarPubMed
Andreasen, NCThe Scale for the Assessment of Negative Symptoms (SANS) Iowa City, IA: University of Iowa, 1983Google Scholar
Awad, AGQuality of life of schizophrenic patients on medications and implications for new drug trials. Hosp Community Psychiatry 1992; 43: 262–5Google ScholarPubMed
Baldessarini, RFrankenberg, FClozapine. A novel antipsychotic agent. N Engl J Med 1991; 324: 746–54Google ScholarPubMed
Bartkó, GFreeska, EHorvath, Set al.Predicting neuroleptic response from a combination of multilevel variables in acute schizophrenic patients. Acta Psychiatr Scand 1990; 82: 408–12CrossRefGoogle ScholarPubMed
Breier, ABuchanan, RWKirkpatrick, Bet al.Effects of clozapine on positive and negative symptoms in outpatients with schizophrenia. Am J Psychiatry 1994; 151: 20–6Google ScholarPubMed
Breier, ASchreiber, JLDyer, Jet al.National Institute of Mental Health longitudinal study of chronic schizophrenia. Arch Gen Psychiatry 1991; 48: 239–46CrossRefGoogle ScholarPubMed
Casey, DEClozapine: neuroleptic-induced EPS and tardive dyskinesia Psychopharmacology 99suppl 1989 S4753CrossRefGoogle ScholarPubMed
Chouinard, GJones, BRemington, Get al.A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacology 1993; 13: 25–40CrossRefGoogle ScholarPubMed
Ciompi, LCatamnestic long-term study on the course of life and aging of schizophrenics. Schizophr Bull 1980; 6: 606–18CrossRefGoogle ScholarPubMed
Claghorn, JHonigfeld, GAbuzzahab, FSet al.The risks and benefits of clozapine versus chlorpromazine. J Clin Psychopharmacol 1987; 7: 377–84CrossRefGoogle ScholarPubMed
Cohen, LJTest, MABrown, RLSuicide and schizophrenia: data from a prospective community treatment study. Am J Psychiatry 1990; 147: 602–7Google ScholarPubMed
Cole, JOGoldberg, SCKleman, GLPhenothiazine treatment in acute schizophrenia. Arch Gen Psychiatry 1964; 10: 246–61Google Scholar
Collins, EJHogan, TPDesai, HMeasurement of therapeutic response in schizophrenia: A critical survey. Schizophr Res 1991; 5: 249–53CrossRefGoogle ScholarPubMed
Drake, GEGates, CWhitaker, Aet al.Suicide among schizophrenics: a review. Compr Psychiatr 1985; 26: 90–100CrossRefGoogle ScholarPubMed
Endicott, JSpitzer, RLA diagnostic interview: the schedule for affective disorders and schizophrenia Arch Gen Psychiatry 1978 837–44CrossRefGoogle Scholar
Endicott, JSpitzer, RLFleiss, Jet al.The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 767–71CrossRefGoogle ScholarPubMed
Hagger, CBuckley, PKenny, JTet al.Improvement in cognitive functions and psychiatric symptoms in treatment-refractory schizophrenic patients receiving clozapine. Biol Psychiatry 1993; 34: 702–12CrossRefGoogle ScholarPubMed
Heaton, RPaulsen, JSMcAdams, LAet al.Neuropsychological deficits in schizophrenics: relationship to age, chronicity, and dementia. Arch Gen Psychiatry 1994; 51: 469–76CrossRefGoogle ScholarPubMed
Helgason, LTwenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been presented?. Acta Psychiatr Scand 1990; 81: 231–5CrossRefGoogle Scholar
Kane, JHonigfeld, GSinger, Jet al.Clozaril Collaborative Study Group: Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–96CrossRefGoogle Scholar
Kay, SRFiszbein, AOpler, LAThe Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76CrossRefGoogle Scholar
Keck, PEPope, HGMcElroy, SLFrequency and presentation of neuroleptic malignant syndrome: A prospective study. Am J Psychiatry 1987; 144: 1344–6Google ScholarPubMed
Kenny, JMeltzer, HYAttention of higher cortical functions in schizophrenia. J Neuropsychiatr Clin Neurosci 1991; 3: 269–75Google Scholar
Lee, MAHagger, CThompson, Pet al.Effects of clozapine on cognitive function in schizophrenia J Clin Psychiatry 55 suppl B1994 91–3Google Scholar
Liddle, PFBarnes, TRESyndromes of chronic schizophrenia. Br J Psychiatry 1980; 157: 558–61CrossRefGoogle Scholar
Lindenmeyer, JPGrochowshi, SMargugat, LClozapine effects on positive and negative symptoms: a six-month trial in treatment-refractory schizophrenics. J Clin Psychopharmacol 1994; 14: 201–4Google Scholar
Malm, UMay, PRADencker, SJEvaluation of the quality of life of the schizophrenic outpatient: A checklist. Schizophr Bull 1981; 7: 477–85CrossRefGoogle ScholarPubMed
Marder, SRMeibach, RCRisperidone in the treatment of schizophrenia. Am J Psychiatry 1994; 151: 825–35Google ScholarPubMed
Meltzer, HYDimensions of outcome with clozapine Br J Psychiatry 160 suppl 17 1992 46–53CrossRefGoogle Scholar
Meltzer, HYTreatment of the neuroleptic non-responsive schizophrenic patients. Schizophr Bull 1992; 18: 515–42CrossRefGoogle Scholar
Meltzer, HYBastani, BKwon, KYet al.A prospective study of clozapine in treatment-resistant schizophrenic patients. I. Preliminary report Psychopharmacology 99 (suppl): 1989 S68–S72CrossRefGoogle ScholarPubMed
Meltzer, HYBurnett, SBastani, Bet al.Effect of six months of clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychiatry 1990; 41: 892–7Google ScholarPubMed
Meltzer, HYCola, PWay, Let al.Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia. Am J Psychiatry 1993; 150: 1630–8Google ScholarPubMed
Meltzer, HYOkayli, GThe reduction of suicidality during clozapine treatment in neuroleptic-resistant schizophrenia: effect on risk-benefit considerations. Am J Psychiatry 1995; 152: 183–9Google Scholar
Meltzer, HYSommers, AALuchins, DJThe effect of neuroleptics and other psychotropic drugs on negative symptoms in schizophrenia. J Clin Psychopharmacol 1986; 6: 329–38CrossRefGoogle Scholar
Miller, DDPerry, PJCadoret, RJet al.Clozapine's effects on negative symptoms in treatment-refractory schizophrenics. Comp Psychiatry 1994; 35: 8–15CrossRefGoogle ScholarPubMed
Möller, HJScharl, Wvon Zerssen, DCan the result of neuroleptic treatment be predicted? An empirical investigation on schizophrenic inpatients. Pharmacopsychiatry 1985; 18: 52–3CrossRefGoogle Scholar
Overall, JEGorham, DThe Brief Psychiatric Rating Scale. Psychol Rep 1962; 10: 149–65CrossRefGoogle Scholar
Pickar, DOwen, RRLitman, REet al.Clinical and biological response to clozapine in patients with schizophrenia. Arch Gen Psychiatry 1992; 49: 345–53CrossRefGoogle Scholar
Reid, WHMason, MToprac, Met al.Savings in hospital bed-days related to treatment with clozapine. Hosp Comm Psychiatr 1994; 45: 261–4Google ScholarPubMed
Revicki, DALuce, BRWechsler, JMet al.Cost-effectiveness of clozapine for treatment-resistant schizophrenic patients. Hosp Comm Psychiatr 1990; 41: 850–4Google ScholarPubMed
Rupp, AKeith, SJThe costs of schizophreniaPowchick, PSchulz, SCThe Psychiatric Clinics of North America 16 Philadelphia: WB Saunders Co, 1993 412–3Google Scholar
Scholz, EDichgans, JTreatment of drug-induced exogenous psychosis in Parkinsonism with clozapine and fluperlapine. Eur Arch Psychiatry Neurol Sci 1985; 235: 60–4CrossRefGoogle ScholarPubMed
Skantze, KMalm, UDencker, SJet al.Comparison of quality of life with standard of living in schizophrenic outpatients. Br J Psychiatry 1992; 161: 797–801CrossRefGoogle Scholar
Strauss, JSCarpenter, WT JrThe prognosis of schizohprenia: rationale for a multidimensional concept. Schizophr Bull 1978; 4: 56–67CrossRefGoogle ScholarPubMed
Thompson, PABuckley, PFMeltzer, HYThe Brief Psychiatric Rating scale: effect of scaling system on clinical response assessment. J Clin Psychopharmacol. 1994; 14: 344–6CrossRefGoogle ScholarPubMed
Thompson, PAMeltzer, HYPositive, negative and disorganisation factors from the Schedule of Affective Disorders and Schizophrenia and the Present State Examination. A three-factor solution. Br J Psychiatry 1993; 163: 111–9CrossRefGoogle ScholarPubMed
Vaccaro, JVYoung, ASGlyson, SCommunity-based care of individuals with schizophreniaPowchick, PSchulz, SCPsychiatric Clinics of North America Philadelphia: WB Saunders Co 1993; 16: 387–99Google Scholar
Van Putten, TDrug refusal in schizophrenia: causes and prescribing hints. Hosp Community Psychiatry 1978; 29: 110–2Google ScholarPubMed
Weiden, PJShaw, EMann, JCauses of neuroleptic noncompliance. Psychiatr Ann 1986; 16: 571–5CrossRefGoogle Scholar
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