Effects of Six Months of Clozapine Treatment on the Quality of Life of Chronic Schizophrenic Patients

Meltzer, Herbert Y.; Burnett, S; Bastani, Bijan; Ramirez, Luis F.

doi:10.1176/ps.41.8.892

Cited by 198 publications

(158 citation statements)

References 12 publications

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“…Some aspects of clozapine's action on cognitive function, which form the basis for its long-term psychosocial benefits, may yet have to be quantified. These long-term psychosocial improvements occur in domains as diverse as quality of life (Galletly et al, 1997;Meltzer et al, 1990), compliance and treatment participation (Rosenheck et al, 1997;Luchins et al, 1998), violent behavior (Buchanan et al, 1998;Glazer and Dickson, 1998;Frankle et al, 2001), and substance abuse (Buckley et al, 1994). The mechanism of clozapine's unique antipsychotic efficacy is not known, but along with its benign motor effect profile, the clinical actions balance the significant agranulocytosis risk of the drug (Alvir et al, 1993).…”

Section: Introductionmentioning

confidence: 99%

Clozapine but not Haloperidol Re-establishes Normal Task-Activated rCBF Patterns in Schizophrenia within the Anterior Cingulate Cortex

Lahti

Holcomb

Weiler

et al. 2003

Neuropsychopharmacol

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Our previous work has identified that unmedicated volunteers with schizophrenia have regional cerebral blood flow (rCBF) activation patterns inappropriately related to the cognitive demand of a task in anterior cingulate cortex (ACC). Using positron emission tomography (PET) with 15 O water, we compared task-induced rCBF patterns induced by haloperidol or clozapine in individuals with schizophrenia. We hypothesized that clozapine, given its superior clinical action, would tend to normalize the abnormal task-activated response in ACC more than haloperidol. Schizophrenia volunteers (SVs) (n ¼ 6) and normal volunteers (NVs) (n ¼ 12) were trained to perform a tone discrimination task with 70-80% accuracy. They were then scanned during three task conditions: (1) Rest, (2) sensory motor control (SMC) task, and (3) decision task (DEC). SVs were initially scanned after withdrawal of all psychotropic medication and again after treatment with therapeutic doses of haloperidol (n ¼ 5) and/or clozapine (n ¼ 5). rCBF values, sampled in the grown maxima of the task-activated ACC cluster, were analyzed between groups and task conditions. Task performance was similar across the unmedicated, haloperidol-and clozapine-medicated SV groups. There was a reduction in accuracy in the haloperidol SV group compared to the NVs. Group and task conditions affected rCBF in the ACC. Clozapine, but not haloperidol, reversed the abnormal ACC rCBF pattern in unmedicated SV to normal. The clozapine-treated SV group showed a rCBF pattern similar to the NV group in that ACC activation was not observed during the control task but occurred during the decision condition. The pattern seen in the haloperidoltreated SV group was similar to the unmedicated SV group in that ACC activation was seen during the control task and no further activation was seen during the DEC. We report that clozapine, but not haloperidol, normalizes anterior cingulate rCBF patterns in schizophrenia during a cognitive task. Based on these preliminary data, we propose that this pattern may account for the superior therapeutic effect of clozapine and represents a surrogate marker of this action.

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Section: Introductionmentioning

confidence: 99%

Clozapine but not Haloperidol Re-establishes Normal Task-Activated rCBF Patterns in Schizophrenia within the Anterior Cingulate Cortex

Lahti

Holcomb

Weiler

et al. 2003

Neuropsychopharmacol

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“…The utility of the QLS in assessing change in deficit status has been highlighted in treatment studies (eg Meltzer et al, 1990;Rosenheck et al, 1997;Hamilton et al, 1998). The importance of the QLS in assessing outcome in schizophrenia research has also been highlighted by the observed relation between neurocognitive impairment and psychosocial status (Green, 1996;Buchanan et al, 1994;Medalia et al, 1998;Wykes et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

“…Others have noted that the four subscales of the QLS are highly related, and provide little additional information beyond the total score. Meltzer et al (1990) reported that both before and after clozapine treatment, all QLS scores from their patient sample were highly intercorrelated and correlated very highly with the total QLS score. Recent investigations of the relation between symptom exacerbation and stabilization and Quality of Life (QOL) have reported QLS total scores, rather than subscale scores, in the light of each subscale's very close relation with the total score (Bow- Thomas et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Development of an Abbreviated Schizophrenia Quality of Life Scale Using a New Method

Bilker

Brensinger

Kurtz

et al. 2002

Neuropsychopharmacol

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The goal of the study was to develop and apply a predictive model approach to reduce the number of items collected for scales that yield a total summary score. A parsimonious subset of items from the 21-item Quality of Life Scale (QLS) that can accurately predict the total scale score was sought and evaluated in 198 patients with schizophrenia, using a statistical modeling approach. Two additional data sets were used for model validation: the subset of 101 patients used in the model construction who had the QLS administered approximately 1 year later and a new sample of 37 patients. Using only seven QLS items as predictors, the correlation was 0.9831 between the predicted and true QLS totals. Applying the model based for these seven QLS items, the correlations from the first and second validation data sets were 0.9791 and 0.9637, respectively. The study demonstrates that a small subset of items of the QLS predicts the entire 21-item scale with high accuracy. Two validation samples have confirmed the finding. This reduces the effort associated with scale administration and is likely to increase the assessment of an important functional domain. Such models can guide efforts for item reduction in other rating instruments.

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“…Além disso, é eficaz em uma proporção subs-Relato do uso de Clozapina -Gama et alii tancial (30 a 60%) de pacientes esquizofrêni-cos que não respondem ou não toleram a terapia com drogas antipsicóticas clássicas. Outros estudos mostram que pacientes com esquizofrenia refratária tratados com clozapina por períodos prolongados (seis meses a dois anos) [33][34][35] obtiveram melhora na adaptação social, integração e funções cognitivas [36][37][38][39] , remissão substancial da doença e conseqüentemente maior afastamento das internações hospitalares, melhor qualidade de vida e potencial de trabalho 37,[40][41][42][43][44][45] .…”

Section: Discussionunclassified

Relato do uso de clozapina em 56 pacientes atendidos pelo Programa de Atenção à Esquizofrenia Refratária da Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul

Gama

Souza

Lobato

et al. 2004

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃO: A Esquizofrenia é transtorno psiquiátrico crônico grave que acarreta importantes déficits psicológicos, sociais e vocacionais. Os antipsicóticos clássicos são amplamente usados como tratamento, mas comumente produzem respostas incompletas, toxicidade e efeitos extrapiramidais. A clozapina foi importante aquisição na terapia antipsicótica. Mostrou-se com eficácia legítima em 30-61% das psicoses e baixa incidência de efeitos adversos. MÉTODOS: Relato da experiência clínica de 56 pacientes com Esquizofrenia Refratária incluídos no programa de fornecimento gratuito da clozapina pela Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul em convênio com o Hospital de Clínicas de Porto Alegre. RESULTADOS: A média dos escores da Brief Psychiatric Rating Scale (BPRS) foi inicialmente 77,9 (DP=16,1) e, após noventa e três meses de tratamento, 41,1 (DP=16,2). Dois pacientes abandonaram o programa e um foi excluído por agranulocitose. Houve quatro internações. DISCUSSÃO: Apesar de sua comprovada eficácia e aplicabilidade, a clozapina não está livre de efeitos adversos: hipotensão ortostática, taquicardia, visão turva, xerostomia, hipersalivação, constipação e sedação são comuns. As alterações hematológicas ocorrem em 0,05 a 2,8% dos casos. Ainda, o alto custo restringe seu uso. CONCLUSÕES: Houve melhora significativa e mantida dos pacientes que participaram do programa. Doenças com maior tempo de evolução obtiveram menor resposta, provavelmente relacionada a alterações neurofisiológicas e neuroquímicas. Vale ressaltar a importância do início precoce do tratamento e a necessidade da participação do Estado, no sentido de oferecer suporte psicossocial e financeiro para a otimização do tratamento desses pacientes.

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Effects of Six Months of Clozapine Treatment on the Quality of Life of Chronic Schizophrenic Patients

Cited by 198 publications

References 12 publications

Clozapine but not Haloperidol Re-establishes Normal Task-Activated rCBF Patterns in Schizophrenia within the Anterior Cingulate Cortex

Clozapine but not Haloperidol Re-establishes Normal Task-Activated rCBF Patterns in Schizophrenia within the Anterior Cingulate Cortex

Development of an Abbreviated Schizophrenia Quality of Life Scale Using a New Method

Relato do uso de clozapina em 56 pacientes atendidos pelo Programa de Atenção à Esquizofrenia Refratária da Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul

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