This report stresses on the occurrence of a rare adverse reaction to clozapine, i.e. allergic cutaneous and visceral angioedema, in a patient with treatment resistant schizophrenia (TRS). We report the case of a schizophrenic patient who was resistant to treatment and developed an allergic reaction involving her skin and gastro-intestinal system upon the commencement of clozapine. She was then treated with a combination pharmacotherapy which left some residual symptoms. The manifestation of allergic reactions to clozapine and its management strategies are discussed in the paper. There is a pressing need to develop a new psychotropic which is on par with clozapine.
Schizophrenia ; Clozapine

Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatmentresistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed.
Clozapine ; Lithium ; Neutropenia ; Schizophrenia

There is no doubt that dopamine plays a critical role in the etiopathogenesis of schizophrenia. However, there appeared some limitations in explaining the complex phenomena of schizophrenia. Recent research data suggest that dysfunction in serotonergic system may be involved Before the dopamine hypothesis of schizophrenia became established, the interest in serotonin(5-ydroxytryptamine, 5-HT) as an etiological substrate of this illness occurred. Recently the importance and extent of 5-HT's involvement in the pathophysiology and mechanism of action of antipsychotic drug is actively investigated. In recent years, therapeutic success of clozapine and risperidones has increased attention on the interaction between the 5-HT and dopamine systems in schizophrenia. This led to the serotonin-dopamine for antipsychotic. The authors review the evidence for the role of 5-HT in schizophrenia and serotonin-dopamine interaction.
Clozapine ; Dopamine ; Schizophrenia* ; Serotonin*

OBJECTIVES: This prospective study was performed to determine effects of clozapine treatment on the quality of life of treatment-resistant schizophrenic patients. METHOD: Subjects were 18 patients with treatment-resistant schizophrenia. Patient's PANSS, BPRS and Simpson-Angus Rating Scale was assessed at 9 time points: baseline, the 2th, 4th, 6th, 8th, 10th, 12th, 16th, and 20th weeks of treatment. We chose to use the Quality of Life Scale (QLS) developed by Heinrichs and associates to evaluate the effect on the quality of life. The QLS was scaled at every month of treatment. RESULTS: Eighteen of twenty-three patients completed the five months trial of clozapine. Three PANSS factors (positive, negative, general) and BPRS total scores showed a significant improvement at the fifth month of clozapine treatment. The adverse effects of clozapine did not show a significant improvement. After five months of clozapine treatment, there were an increase of 52.69% in the total QLS score and a significant improvement of two QLS factors (interpersonal relations, intrapsychic foundation). Particularly two PANSS factors(negative, general) had a significant correlation with the QLS score. CONCLUSIONS: This study suggests that clozapine treatment has a positive effect on quality of life of treatment-resistant schizophrenic patients.
Clozapine* ; Humans ; Prospective Studies ; Quality of Life* ; Schizophrenia

To assess the efficacy and safety of combining electroconvulsive therapy(ECT) and clozapine in patients with treatment-resistant schizophrenia, the authors reviewed use of this combination in one treatment-resistant schizophrenic inpatient and to explain the mechanism of this combination, we measured the blood level of clozapine and its metabolite with high performance liquid chromatography(HPLC) before, during and after this combination. The combination of clozapine and bilateral ECT was mildly effective and the authors saw no adverse effects during combined treatment. The blood levels of clozapine and its metabolite did not significant change before, during and afyer this combination. Combining ECT and clozapine appears to be safe and is effective without significant change of the blood levels of clozapine and its metabolites in some patients with treatment-resistant schizophrenia.
Clozapine* ; Electroconvulsive Therapy* ; Humans ; Inpatients ; Schizophrenia

Atypical antipsychotics are the more effective and safer alternative to the common practice of maintenance adjunctive treatment as well as acute adjuvant treatment with traditional antipsychotics in patients with bipolar disorder. A few double-blind controlled studies of acute mania found olanzapine or ziprasidone monotherapy to be more effective than placebo, and the combination treatment of risperidone and mood stabilizer was also more effective than placebo. Furthermore, clozapine has antimanic and mood stabilizing effect for the treatment-refractory patients in acute manic and maintenance phase. Olanzapine and risperidone are reported that they have long-term mood stabilizing effect when they are used with mood stabilizers. At present, combination treatment of atypical antipsychotics and mood stabilizer is generally used. However, because each drug of such combinations causes sometimes bothersome and potentially dangerous events as well as their interactions, the consideration for their risk are needed.
Antipsychotic Agents* ; Bipolar Disorder* ; Clozapine ; Humans ; Risperidone

The objective of our study was to examine the electroencephalogram (EEG) abnormalities associated with clozapine treatment. It was a cross-sectional study on 87 psychiatric patients on clozapine treatment. 32 channel digital EEG was recorded and analysed visually for abnormalities. EEG abnormalities were observed in 63.2% of patients. Both slowing and epileptiform activities were noted in 41.4% of patients. The EEG abnormalities were not associated with dose or duration of clozapine exposure.
Clozapine ; Cross-Sectional Studies ; Electroencephalography ; Humans ; Seizures

Nocturnal enuresis has been recognized as an adverse effect of clozapine treatment. We reported 3 chronic schizophrenic patients who had showed nocturnal enuresis following clozapine treatment. Oxybutynin hydrochloride on clozapine-induced enuresis was very effective in 3 patients. The dose in our patients was 5 to 10mg/day. This medication was well tolerated. It is suggested that oxybutynin hydrochloride is a effective therapeutic option in clozapine-induced nocturnal enuresis.
Clozapine* ; Enuresis ; Humans ; Nocturnal Enuresis* ; Schizophrenia

OBJECTIVES: The present study aimed to determine the optimal clozapine dosage in Korean adult schizophrenic patients, and to measure the blood levels of clozapine and its major metabolites. METHODS: Thirty schizophrenic patients, who have undertaken clozapine over 1 year, were recruited in this study. We investigated the clozapine dose at different times(2, 4, 8, 12, 24, 52 weeks) during the course of treatment with clozapine and we measured the blood level of clozapine and its major metabolites, N-desmethylclozapine and clozapine-N-oxide by using high performance liquid chroma-tography(HPLC). RESULTS: The average dosages of clozapine at 2, 4, 8, 12, 24, 52 weeks were 22.5(+/-92.2), 330.0 (+/-139.2), 344.8(+/-80.6), 327.5(+/-93.4), 288.3(+/-118.5), 239.3(+/-112.3)mg/day respectively. The average clozapine dose of male schizophrenics was significantly higher than that of female schizo-phrenics after 8 weeks during the course of treatment. But there were no significant differences in blood level of clozapine and its major metabolites between genders in same dosage of clozapine. The average dose of clozapine in smokers was slightly higher than non-smokers, but there was no statistical significance. The blood levels of clozapine and its major metabolites was significantly correlated with the total dose of clozapine. CONCLUSION: The average clozapine dose of Korean adult schizophrenics was lower than that of reported Caucasian data, and to reach the known therapeutic clozapine blood level above 350-400 ng/ml, we need 300-400mg/day of clozapine.
Adult* ; Clozapine* ; Female ; Humans ; Male ; Schizophrenia

This study explored long-term changes in self-report auditory verbal hallucinations (AVHs) among patients with schizophrenia taking clozapine. Forty-four patients who were evaluated more than twice and were above the mild severity category on the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) were enrolled. The mean observation period was 492.5±350.1 days (median, 452 days). The mean total, physical, and emotional factor scores on the HPSVQ were significantly reduced from baseline to the final observations except for one item “interference with life,” which was not significantly reduced. Regarding the time-dependent longitudinal changes modeled using linear mixed-effect regression, the total and physical factor scores showed significant changes during the first year, but the emotional factor score did not satisfy a more stringent level of significance. Female gender was negatively associated with the reduction in total and physical factor scores. The duration of treatment with clozapine also had a negative relationship with the reductions in all three scores.
Clozapine ; Female ; Hallucinations ; Humans ; Schizophrenia ; Voice