난치성 정신분열증환자의 Clozapine 장기치료효과

Efficacy of Long-term Treatment with Clozapine in Refractory Chronic Schizophrenia

Objects : The long-term efficacy of clozapine treatm ent was exam ined in an open prospective study, in order to ascertain w hether the short-term therapeutic gains of clozapine w ould persist d uring long-term maintenance therapy and whether it is safe and well tolerated. M ethods : We investigated clozapine’ sefficacy and its side effects in 21 patients with refractory chronic schizophrenia, who had previously been treated with different kinds of classical antipsychotic drugs but with insufficient clinical effect or distressing extrapyram idal side effects, over a one-year period. None of the patients received concom itant m edications such as hypnotics or anticholinergics during the study period. Results : Psychopathology and extrapyram idal symptoms were assessed every 4 weeks until the end of the 24 weeks using the PANSS, CGI and Simpson-A ngus Scale. All rating scores dem onstrated a significant im provem ent from the 4th week through the 48th week of the study period compared with the baseline. Aclinically significant im provem ent in both PAN SS total and negative scale scores was to start at the 10th month and continue through the 12th month of the study period, com pared with the 3rd month period, the standard short-term evaluation period. 16(76.3% ) of the 21 patients responded within 9 months with a 20% or more decrease in the total PA NSS. Using a 50% or h igher decrease in the total PANSS, we found 5 responders, within up to 12 month so ftreatment Of these, one responded at 3 months, another one at 9 months, and another three at 12 months. The tolerability of clozapine was generally found to be good. H ypersalivation(81 % )􀃥drow siness(81 % ) and constipation(57 % ) were the most common side effects ; all of these side effects show ed a significant decrease on 9 —12 months of clozapinead ministration com pared with the first three m onths of drug adm inistration. Conclusion : These results suggest that clozapine may be a useful antipsychotic drug for the long - term treatment of chronic schizophrenics, despite the need for regular blood monitoring. A trial of clozapine should last 10 months or longer if one wishes to identify the possible responders.