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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most of the experience with the atypical neuroleptic of Clozapine (Leponex, Sandoz) pertains to active treatment. In conjunction with possible risks, at present its administration in selected groups of patients is recommended. The authors describe the results of an intraindividual comparison of Clozapine in 11 patients with the diagnosis of schizophrenia (according to ICD-9), 7 men, mean age 30.5 years with previous neuroleptic treatment. The average period for comparison was 2.3 years (1.5-4 years), the mean daily dose of Clozapine was 200 mg (50-400 mg). During Clozapine treatment the hospitalization period was significantly shorter and the number of hospital admissions was lower. The frequency of undesirable effects was equal during both periods. During Clozapine treatment morning sleepiness and hypersalivation were more frequent and during treatment with neuroleptics extrapyramidal undesirable effects. In none of the patients they caused discontinuation of treatment. Transient leukopenia after Clozapine in one patient was improved after reduction of the dose. The paper is supplemented by the case-history of female patient treated by Clozapine monotherapy during 17 years.
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PMID:[Maintenance therapy in schizophrenia using clozapine]. 191 53

The effect of long-term treatment with clozapine in schizophrenia and schizoaffective disorder was evaluated in a retrospective study comprising 96 patients treated with the drug during the period 1974-1986 at the Psychiatric Research Center in Uppsala. All patients had previously been treated with different kinds of antipsychotic drugs but with insufficient clinical effect or distressing extrapyramidal side effects. When clozapine treatment was initiated, the mean duration of the illness was 8 years and 9 months. In 36% of the patients clozapine treatment was discontinued, the main reasons being lack of efficacy, poor compliance or temporary withdrawal from the market in 1975. Clinical evaluation of the effect revealed that 85% of the patients could be discharged from the hospital within a year and that 43% of the patients were significantly and 38% moderately improved compared to previous treatments. Of those patients who were still on clozapine 2 years after the treatment was initiated, 39% had employment compared to only 3% before clozapine. In ten patients a transient decrement in white blood cells (WBC) was noted but normalized during ongoing treatment. One patient developed leukopenia and one agranulocytosis, none with fatal outcome. Common side effects were sedation, hypersalivation, weight gain and obstipation. In one patient clozapine treatment was stopped because of grand mal seizures. No extrapyramidal side effects were observed or reported during clozapine treatment. It is concluded that clozapine offers particular advantages for many "therapy-resistant" schizophrenic patients when compared to classical neuroleptics.
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PMID:A retrospective study on the long-term efficacy of clozapine in 96 schizophrenic and schizoaffective patients during a 13-year period. 281 70

A patient with gout and schizophrenia is described who during a schizophrenic paroxysm with paranoid-hypochondriac-hallucinatory syndrome attempted to commit suicide and took 200 tablets milurit (20 g). He developed the picture of acute intoxication with nausea, vomiting, profuse diarrhea, abdominal pain, flushing, temperature, collapse manifestations, hepatomegaly, direct hyperbilirubinemia, elevated transaminase, leukopenia, accelerated ESR. After reanimation and infusion therapy, the patient recovered within 4 days and 2 weeks later all blood indices reached the limits of the norm.
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PMID:[Acute allopurinol (milurit) poisoning]. 402 4

Serotonin-dopamine antagonists (SDAs) offer the possibility of improved treatment of schizophrenia compared with conventional neuroleptics and have superior safety profiles. Clinical trial data have so far been published for only three SDAs to date, namely, risperidone, sertindole, and olanzapine. Of these, extensive data are available only for risperidone, showing that at doses of 4 to 16 mg/day, it is superior to haloperidol at 10 to 20 mg/day. Furthermore, risperidone, 6 and 16 mg/day, significantly improved negative/symptoms, whereas 20 mg/day of haloperidol was ineffective. Risperidone also appears to cause fewer extrapyrimidal symptoms (EPS) than haloperidol, 10 or 20 mg/day. Similar advantages of risperidone over perphenazine have also been found. A clinical trial of sertindole showed that, at 20 mg/day, it was equivalent to haloperidol, 16 mg/day, and caused fewer EPS. Olanzapine, a chemical derivative of clozapine, has also been shown to be superior to haloperidol (10 to 20 mg/day) at doses of 7.5 to 17.5 mg/day. In addition, at doses of 12.5 to 17.5 mg/day, olanzapine was found to have a significantly superior effect on negative symptoms over haloperidol, 10 to 20 mg/day. Doses of up to 17.5 mg/day of olanzapine also caused fewer EPS than haloperidol, 10 to 20 mg/day. There was no evidence of any leukopenia in patients treated with olanzapine in this small study (N = 335). The low EPS liability of these SDAs, combined with their efficacy, suggests that SDAs should become the mainstay of treatment for schizophrenia.
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PMID:Clinical efficacy of serotonin-dopamine antagonists relative to classic neuroleptics. 753 85

Clozapine, as the model agent for the atypical antipsychotic drugs, is currently recommended as effective regarding negative symptoms of schizophrenia and treatment-resistant schizophrenic patients. This study focuses on the clozapine-induced side-effects in 100 hospitalized schizophrenic patients (negative and therapy-resistant forms), followed-up for a four year period. Clinically relevant side-effects occurred in 73% of all patients. Tachycardia (67%), the increase of liver enzymes (36%), hypotension (29%) and sedation (27%) were most frequent. Tachycardia, hypotension and sedation disappeared during the initial phase of treatment (i.e. 4-6 weeks), as tolerance developed with continuation of therapy. The increase of liver enzymes appeared to be dose related, since the reduction of daily clozapine dose led to the normalization of transaminases values. The other side-effects (constipation, nausea and vertigo) were rare and transient. Leucopenia was not registered in any patient during the follow-up period. Therefore, clozapine is efficient and, with some precautions concerning hepatotoxicity, is safe for in- and outpatient long-term treatment in appropriately selected patients.
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PMID:The side-effects of clozapine: a four year follow-up study. 807 87

Clozapine has been shown to have superior effectiveness compared with classic neuroleptics in treating refractory schizophrenia in Caucasians, but its efficacy and safety in Chinese have not been adequately studied. Forty Chinese schizophrenic patients were recruited in a 12-week, double-blind, comparative trial. Twenty-one patients were randomly assigned to clozapine treatment and 19 to chlorpromazine treatment. The average dose was 543 +/- 157 and 1163 +/- 228 mg/day for clozapine and chlorpromazine, respectively. The results showed that six clozapine-treated patients (28.6%) had more than 20% improvement in Brief Psychiatric Rating Scale score and were classified as responders, whereas none of the chlorpromazine-treated patients was classified as a responder. The degree of improvement in positive symptoms, negative symptoms and Brief Psychiatric Rating Scale scores in the clozapine group was inversely correlated with the severity of negative symptoms at entry into the trial. Two clozapine-treated patients were withdrawn from the study, one because of leukopenia and nausea, and the other because of vomiting and hypotension. Chlorpromazine treatment was prematurely discontinued in two patients, because of jaundice and over sedation in one, and because of severe weight loss in the other (9 kg). The rate of moderate-to-severe sialorrhea was high in clozapine-treated patients (28.6%). Two clozapine-treated patients and two chlorpromazine-treated patients showed significant improvement in previously existing tardive dyskinesia and one chlorpromazine-treated patient exhibited aggravation of tardive dyskinesia. The results of this study indicate that clozapine treatment might have advantages over chlorpromazine for Chinese schizophrenic patients who are refractory to typical neuroleptic treatment.
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PMID:A double-blind comparative study of clozapine versus chlorpromazine on Chinese patients with treatment-refractory schizophrenia. 924 67

Clozapine represents the "gold standard" therapy for treatment-resistant schizophrenia including use for symptom reduction and use in patients intolerant of extrapyramidal side effects associated with other antipsychotics. Despite its clear benefit in these areas, its use has been associated with a serious, and sometimes life-threatening, risk for agranulocytosis. Effective white blood cell monitoring systems have been developed by Novartis affiliates across the world to ensure its safe use and to meet local health standards. The goals of the monitoring programs include: (1) weekly white blood cell monitoring during the initial months of therapy for early detection of severe leukopenia; (2) immediate discontinuation of clozapine if severe leukopenia is observed; (3) exclusion from reexposure to clozapine if a patient experiences clozapine-induced agranulocytosis; and (4) early cessation of treatment if hematologic guidelines are not followed ("no blood, no drug" policy). Together, these systems have demonstrated a worldwide reduction in the observed rate of agranulocytosis and in fatalities related to the emergence of agranulocytosis when rigorous monitoring systems are in place.
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PMID:Clozapine: the commitment to patient safety. 1037 10

We used L-(quinoxalin-6-ylcarbonyl)piperidine (CX516) (a modulator of the alpha-amino-3-hydroxy-5-methyl-4-isoxasole propionic acid (AMPA) receptor) as a sole agent in a double blind placebo-controlled design in a small series of patients with schizophrenia who were partially refractory to treatment with traditional neuroleptics. The study entailed weekly increments in doses of CX516, from 300 mg tid for week 1 up to 900 mg tid on week 4. Patients were followed with clinical ratings, neuropsychological testing, and were monitored for adverse events. Four patients received 2 to 4 weeks of CX516, two received placebo and two withdrew during the placebo phase. Adverse events associated with drug administration were transient and included leukopenia in one patient and elevation in liver enzymes in another. No clear improvement in psychosis or in cognition was observed over the course of the study. CX516 at the doses tested did not appear to yield dramatic effects as a sole agent, but inference from this study is limited.
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PMID:Preliminary experience with an ampakine (CX516) as a single agent for the treatment of schizophrenia: a case series. 1222 53

To examine clinical features of pneumonia in schizophrenics, its course was analysed in 115 patients of a mental hospital (91 men, 24 women, mean age 54.4 +/- 1.2 years). 63.3% patients stayed in hospital for more than a year, 70.4% had schizophrenia for 20 years. 86% pneumonia patients were at the age older than 40 years, 35%--older than 60 years. Unfavourable premorbid factors were dementia, weight loss, anemia, recurrent pneumonia and intestinal infections. Pneumonia was characterized by rare fever, pains in the chest, frequent hypotension, systemic symptoms. 58.2% of patients suffered from pneumonia longer than 4 weeks. Lethality was 23.5%. In patients who had schizophrenia up to 10 years lethal outcomes were absent. In lethal outcome, pneumonia was initially diagnosed as severe, it was accompanied by arterial hypotonia in 91.7% of cases, by leukopenia in 40.5% (below 10(9)/l). Lethal outcome was caused by rapid development of brain edema in vascular failure in more than half of the cases. Pneumonia in mental patients was connected with many factors: the disease as such, psychotropic therapy, conditions in the hospital stay.
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PMID:[Clinical characteristics of pneumonia in schizophrenics]. 1293 15

Clozapine remains one of the most commonly used antipsychotic medications in China. As China has the largest population internationally on clozapine treatment, its experience and research findings are of keen interest to Western psychiatrists. However, most of the related papers have hitherto been published only in Chinese language journals. Here we review mainly Chinese-language publications on the use of clozapine in China. A descriptive study based on literature identified from searches of Medline and the China National Knowledge Infrastructure (CNKI) databases (1979-2007), and other hand-picked references. Unlike the situation in other countries, clozapine is still widely used for a number of psychiatric disorders in China, though the prescription of other second-generation antipsychotics (SGAs) is also increasing. About 25-60% of all treated patients with schizophrenia receive clozapine; and clozapine is preferred by some as a first-line treatment for schizophrenia. Clozapine is also used for other conditions such as mania, treatment-resistant depression and drug abuse. The average daily dose is between 200 and 400 mg. The incidence of leukopenia is 3.92% and agranulocytosis 0.21% in China, with about one third of reported cases of patients with agranulocytosis dying. Weight gain and clozapine-associated diabetes are also commonly reported in the Chinese population. Clozapine is currently the most commonly used treatment for schizophrenia in China. Chinese psychiatrists need to pay more attention to its potential toxic side effects when they make drug choices.
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PMID:Clozapine in China. 1820 45


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