Clozapine is an atypical antipsychotic drug with minimal extrapyramidal toxicity recently approved by the Food and Drug Administration for hard-to-treat schizophrenic patients. We reviewed information on 1,418 patients treated with clozapine in the United States between 1972 and 1988. Forty-one of 1,418 (2.8%) patients had generalized tonic-clonic seizures during treatment with clozapine. Life-table analysis predicts a cumulative 10% risk of seizures after 3.8 years of treatment. Clozapine-related seizures appear to be dose-related. High-dose therapy (greater than or equal to 600 mg/day) was associated with a greater risk of seizures (4.4%) than medium (300 to 600 mg/day; 2.7%) or low doses (less than 300 mg/day; 1.0%). Also, rapid upward titration may increase seizure risk. Thirty-one of 41 patients were successfully continued on clozapine despite seizure occurrence, either with reduction of dose or addition of an antiepileptic medication. Recognition and treatment of clozapine-related seizures will become increasingly important as its use grows in the 1990s.
The NOSIE-30 is a highly sensitive ward behavior rating scale. Final item selection includes the best 30 of an original pool of 100 items, tested on a sample of 630 chronic schizophrenic patients. Both status (pre-treatment) and change (post minus pre-treatment) item responses were factor analyzed. Six factor scores are obtained: Social Competence, Social Interest, Personal Neatness, Irritability, Manifest Psychosis, and Retardation. Cross-validation of these six factor scores and a composite score, Total Patient Assets, was obtained in an independent, double-blind drug study conducted by the NIMH-Psychopharmacology Service Center. The NOSIE-30, especially designed for use by subprofessional personnel, provides an economical and accurate means of systematically assessing patient status and change.
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PROBLEMThe NOSIE was developed specifically to meet the "chronic" need for a behavior rating scale sufficiently sensitive to measure therapeutic change in the older schizophrenic patient. This patient group is relatively asymptomatic, and often characterized by apathy and indifference. Because of this, symptom rating scales are usually not particularly relevant in this class of patients. Further, many of 'Chief, Experimental Studies, Central NP Research Laboratory, VAH, Perry Point, Maryland. Thief, Central S P Research Laboratory, VAH, Perry Point, Maryland. Demands the attention of the doctors. (DEP) Hm temper tantrums. QRR) Reaieta suggestions and requests. (IRR) Shouts and yells. (IRR)
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