PMID- 12716249
OWN - NLM
STAT- MEDLINE
DCOM- 20030701
LR  - 20190901
IS  - 0160-6689 (Print)
IS  - 0160-6689 (Linking)
VI  - 64
IP  - 4
DP  - 2003 Apr
TI  - Clozapine in treatment-resistant patients with schizophrenia, schizoaffective 
      disorder, or psychotic bipolar disorder: a naturalistic 48-month follow-up study.
PG  - 451-8
AB  - BACKGROUND: The aim of this study was to evaluate the long-term efficacy and 
      safety of clozapine in patients with treatment-resistant schizophrenia, 
      schizoaffective disorder, or bipolar disorder with psychotic features. METHOD: 
      101 patients with a DSM-III-R diagnosis of schizophrenia (N = 34); 
      schizoaffective disorder, bipolar type (N = 30); or bipolar disorder with 
      psychotic features (N = 37) were naturalistically treated with clozapine at 
      flexible doses over a 48-month period. Data were collected from 1994 to 2000. The 
      Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impressions-Severity of 
      Illness scale total predicted scores over time were estimated with random-effects 
      regression models. Time to response to clozapine, defined as 50% reduction of 
      BPRS score, was analyzed in the 3 diagnostic groups using the Kaplan-Meier 
      method. Survival curves were compared using the log-rank test. RESULTS: The BPRS 
      total predicted score halved its baseline value in 3 months for bipolar disorder 
      patients, in 6 months for schizoaffective disorder patients, and in 24 months for 
      schizophrenia patients. The proportion of subjects who satisfied the criterion 
      for response to clozapine after 48 months of follow-up was significantly (p <.01) 
      higher in the schizoaffective and bipolar disorder groups (90.0% and 83.8%, 
      respectively) than in the schizophrenia group (64.7%). Baseline scores on the 
      Global Assessment of Functioning (GAF) showed low levels of psychosocial and 
      occupational functioning in all 3 groups. After 48 months of treatment, GAF 
      scores showed a functional improvement in all 3 groups, with significantly (p 
      <.01) greater improvement in the bipolar disorder group compared with the other 
      groups. CONCLUSION: The findings of this study confirm the efficacy and safety of 
      clozapine for treatment-resistant patients with a diagnosis of schizophrenia, 
      schizoaffective disorder, or bipolar disorder with psychotic features. Patients 
      with schizoaffective disorder and those with bipolar disorder show greater 
      clinical improvement than those with schizophrenia. Patients with bipolar 
      disorder have the shortest time to response and the highest psychosocial and 
      occupational functioning levels. Patients with schizoaffective disorder have the 
      lowest treatment discontinuation rate.
FAU - Ciapparelli, Antonio
AU  - Ciapparelli A
AD  - Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, 
      University of Pisa, Italy. ciapparelli.a@tin.it
FAU - Dell'Osso, Liliana
AU  - Dell'Osso L
FAU - Bandettini di Poggio, Adolfo
AU  - Bandettini di Poggio A
FAU - Carmassi, Claudia
AU  - Carmassi C
FAU - Cecconi, Donatella
AU  - Cecconi D
FAU - Fenzi, Melania
AU  - Fenzi M
FAU - Chiavacci, Maria C
AU  - Chiavacci MC
FAU - Bottai, Matteo
AU  - Bottai M
FAU - Ramacciotti, Carla E
AU  - Ramacciotti CE
FAU - Cassano, Giovanni B
AU  - Cassano GB
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
RN  - 0 (Antipsychotic Agents)
RN  - J60AR2IKIC (Clozapine)
SB  - IM
MH  - Adult
MH  - Antipsychotic Agents/*therapeutic use
MH  - Bipolar Disorder/diagnosis/*drug therapy
MH  - Brief Psychiatric Rating Scale
MH  - Clozapine/*therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Patient Dropouts
MH  - Psychiatric Status Rating Scales
MH  - Psychotic Disorders/diagnosis/*drug therapy
MH  - Schizophrenia/diagnosis/*drug therapy
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2003/04/29 05:00
MHDA- 2003/07/02 05:00
CRDT- 2003/04/29 05:00
PHST- 2003/04/29 05:00 [pubmed]
PHST- 2003/07/02 05:00 [medline]
PHST- 2003/04/29 05:00 [entrez]
AID - 10.4088/jcp.v64n0416 [doi]
PST - ppublish
SO  - J Clin Psychiatry. 2003 Apr;64(4):451-8. doi: 10.4088/jcp.v64n0416.