Observations from a clinical study of 134 chronic psychotic patients, treated with clozapine for up to 12 years

The aim of this study was to estimate the influence of long-term treatment with clozapine upon 134 chronic psychotic patients who were initially hospitalized in the 15th Psychiatric Department of the Psychiatric Hospital of Attica and followed up, thereafter, as outpatients, for a period of time extending up to 12 years (1987-1999).

Of them, 117 (83.3%) were schizophrenics while the others suffered from Schizoaffective Disorder (11), Bipolar Mood Disorder, Type (2), Recurrent Major Depression (2) and Childhood Disintegrative Disorder (2). The mean illness duration was 19.37.9 years and the mean duration of hospitalization 8.37.6 years.

They had all been previously treated with various anti psychotic agents, with non-satisfactory result or with serious side-effects. The mean duration of clozapine treatment was 38.539.2 months and the mean daily dose 381.761.5 mg.

The condition of 91 patients (67,9%), out of 134, improved, Of those 66 (49.3%) exhibited a significant improvement up to full remission of psychopathology in certain cases. The improvement concerned positive as well as negative symptoms extending of a period of time to more than one year, after the onset of clozapine treatment.

In the remaining 43 patients (32.1%), treatment was soon interrupted, either because of poor therapeutic result, or other reasons with negative consequences. For some patients, a concomitant treatment with other antipsychotic, benzodiazepines, Li or antidepressants was required for some time, without significant consequences on the incidence or severity of side-effects.

On only 9 patients (6.7%) serious side-effects were manifested which could not be managed.

More over, at the end of the follow up period, 41 patients among those who continued clozapine treatment (48.7%) in contrast to 9 among those to whom this treatment was interrupted (18.4%) lived permanently in the community, with a significantly lower mean duration of hospitalization per year of illness duration (4.44.8 vs 6.14.4 months).

In conclusion, the view that clozapine is a significantly effective antipsychotic drug, with a good risk/benefit relation, was clearly confirmed by the data of the present paper.