Clozapine in refractory schizophrenia

Herrera, John M.; Costa, Jerome; Sramek, John J.; Heh, Chris

doi:10.1016/0920-9964(88)90008-4

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…This holds true for both measures, a priori hypotheses and baseline-endpoint change (Kane et al 1988;Herrera et al 1988;Conley et al 1988;Pickar et al 1992;Kumra et al 1996). One report failed to establish superiority with respect to an a priori hypothesis (Rosenheck et al 1997), although clozapine did demonstrate significantly greater improvement versus the comparative drug, haloperidol, when baseline-endpoint change was measured for the PANSS (Rosenheck et al 1997).…”

Section: Refractory Schizophreniamentioning

confidence: 83%

“…In the four remaining studies where data are reported in this respect, a significant difference was found between clozapine and conventional agents, even when a lower potency typical antipsychotic had been used. These included chlorpromazine (Herrera et al 1988;Peuskens and Link 1997), perphenazine (Hoyberg et al 1993), and zuclopenthixol (Huttunen et al 1995). As it currently stands, only clozapine has demonstrated improvement on EPS when compared to lower potency conventional antipsychotics, although no such comparative studies have been reported for either sertindole or ziprasidone.…”

Section: Discussionmentioning

confidence: 96%

“…Clozapine proved superior in terms of positive symptoms, with less EPS and prolactin elevation, although no significant differences were reported for negative symptoms, BPRS total score, or depression. Herrera et al 1988 No -Yes-R - Conley et al 1988 No statistical -Yes-R -analysis Pickar et al 1992 Yes Yes Yes Yes Kumra et al 1996 No a -Yes-R Yes Rosenheck et al 1997 Yes -Yes-R Yes Buchanan et al 1998 Yes -No-R No Risperidone Claus et al 1992No No No-R No Borison et al 1992Yes -No No Chouinard et al 1993 Yes -Yes No (dose dependent) (dose dependent) Hoyberg et al 1993No -No No Huttunen et al 1995 No Finally, a 12-week, single-blind, crossover trial comparing these two agents also found significant differences in terms of side effects but not clinical symptoms (Daniel et al 1996). Seventeen of 20 individuals completed the protocol, and no differences were found on the PANSS total score, subscale scores, or Clinical Global Impression scale (CGI).…”

Section: Novel Versus Novel Antipsychotics: How Do They Measure Up?mentioning

confidence: 97%

“…Two reports failed to demonstrate clozapine's superiority in this respect, although in one of these prophylactic antiparkinsonian medication was used in the haloperidol-treated groups (Kumra et al 1996). The second study used quite high doses of both neuroleptics, that is clozapine 900 mg versus chlorpromazine 1800 mg daily, and did not report details regarding EPS scores or use of antiparkinsonian medications (Herrera et al 1988).…”

Section: Epsmentioning

confidence: 99%

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Atypical antipsychotics: are some more atypical than others?

Remington¹,

Kapur

2000

Psychopharmacology

140

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On the heels of clozapine, we now have a number of newer agents (risperidone, olanzapine, quetiapine, sertindole, and ziprasidone). Are they all the same? What are the differences? How do we best understand them? In this article we review current clinical evidence to compare these issues on four measures of atypicality: EPS, prolactin elevation, superior efficacy in refractory/positive symptoms and efficacy against negative symptoms. All the newer agents are superior on EPS and, with the exception of risperidone, avoid prolactin elevation. Clozapine shows the most convincing efficacy in refractory schizophrenia, although comparative data concerning risperidone's benefit in this respect are also emerging. It is unclear, however, whether any of the agents produce a greater effect than conventional antipsychotics against positive symptoms in responsive patients. Both clozapine and olanzapine have demonstrated superior efficacy against negative symptoms, although it remains controversial whether this is an effect on primary or secondary symptoms. The precise pharmacologic mechanisms underlying "atypicality" remain unclear, but several conceptual frameworks are highlighted that characterize, and perhaps differentiate, these newer agents.

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Section: Refractory Schizophreniamentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Section: Novel Versus Novel Antipsychotics: How Do They Measure Up?mentioning

confidence: 97%

Section: Epsmentioning

confidence: 99%

See 2 more Smart Citations

Atypical antipsychotics: are some more atypical than others?

Remington¹,

Kapur

2000

Psychopharmacology

140

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“…We found 14 reports of prospective double-blind controlled trials of atypical antipsychotics claiming to have been undertaken in resistant or refractory schizophrenia. Only three of these studies gained a refractory rating of 5: the Kane study itself (Kane, 1988) (Table 2), a subgroup, single-centre analysis from the Kane study (Herrera et al, 1988) and a small investigation of the effect of risperidone and haloperidol on the perception of emotion (Kee et al, 1998). The first of these clearly showed clozapine to be very much superior to chlorpromazine in very robustly defined treatment refractory subjects.…”

Section: Prospective Double-blind Controlled Trialsmentioning

confidence: 99%

Refractory schizophrenia and atypical antipsychotics

Taylor¹,

Duncan-McConnell

2000

J Psychopharmacol

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Treatment resistant or refractory schizophrenia is a difficult to define condition of largely unknown prevalence. For 10 years, clozapine has been the standard treatment in this condition and is recognized unequivocally as being effective. However, clozapine is sometimes poorly tolerated and has the potential for severe toxicity. Partly as a result of this, other atypicals have recently been evaluated as treatments for refractory schizophrenia. In order to evaluate the evidence base relating to the drug treatment of refractory schizophrenia, we developed a refractoriness rating based on previous work. Using this rating, we assessed all trials of atypicals in schizophrenia unresponsive to at least one drug. Overall, clozapine was consistently shown to be effective in refractory schizophrenia, even when stringently defined. Data relating to olanzapine and risperidone are equivocal at best, and there is some evidence to suggest that they are less effective than clozapine. There is essentially no cogent evidence to support the use of any other atypical in refractory schizophrenia. Clozapine remains the drug of choice in this condition.

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