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Clozapine in the back wards
T C Manschreck1, D A Redmond, S M Beaudette
1Dartmouth Medical School, Concord, New Hampshire 03301, USA.
Summary
Clozapine treatment demonstrated significant improvement in 94% of chronically hospitalized patients. This antipsychotic medication can reduce symptoms and healthcare costs, even in severe cases.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Medicine
Background:
- Clozapine is used for treatment-refractory schizophrenia, but data on chronically institutionalized patients are limited.
- This population represents an extreme of treatment resistance with poor functioning.
Purpose of the Study:
- To evaluate the clinical outcome of clozapine in persistently hospitalized, treatment-refractory patients.
- To assess psychopathology, cognitive function, side effects, and patient satisfaction.
Main Methods:
- Open-label trial analysis of 50 institutionalized patients receiving clozapine.
- Outcomes assessed included psychopathology, cognition, extrapyramidal side effects (EPS), and patient satisfaction.
Main Results:
- 94% of patients showed some improvement with clozapine.
- Improvements included reduced psychopathology, fewer extrapyramidal side effects (EPS), decreased use of restraint/seclusion, and reduced care costs.
- Some patients experienced remarkable improvement, including discharge from the hospital.
Conclusions:
- Clozapine is effective in a majority of chronically institutionalized, treatment-refractory patients.
- Adequate trials of clozapine may require more than six months for optimal assessment.
- Clozapine offers benefits beyond symptom reduction, including improved social interaction and cost-effectiveness.