Results and side effects of treatment with clozapine (leponex R)

Abstract

In the basle Psychiatric University Out-Patient-Clinic 93 randomly chosen patients treated with clozapine were specially examined from 1973–1975. (The percentages are mentioned even when the numbers are small, to give possibilities of comparison.) In schizophrenics the same results were registered when clozapine was given alone or when it was combined with other psychotropic drugs. The young age group of these patients, however, showed more often a deterioration ( p < 0.01) in patients treated with clozapine alone. Out of the schizophrenics we had the best results with pure paranoid states, with hebephrenics and catatonics, the least success with paranoid-depressive states ( p < 0.01) who showed the same results under clozapine alone and under a combined treatment. The paranoid schizophrenics showed less often a deterioration under treatment with clozapine alone ( p < 0.05). The patients with mixed psychoses, manic-depressive psychoses, and involutional depressions showed the same results under clozapine alone and when clozapine was combined with antidepressants and lithium salts. In the treatment of abnormal psychic developments, including neuroses, the same results were obtained when clozapine was given alone or in combination with other drugs. But in this realm it can never be decided definitely what is the psychotherapeutic and what the psychopharmacological effect. Among the side-effects the most serious are the disturbances of hematopoesis. In 9 (25%) of the 36 patients examined with respect to their hematological status, disturbances were registered: 5 patients suffered from leukopenia (except for one all of them had had previous treatments with other major tranquilizers), 6 showed a decrease in polymorphonuclear neutrophils, 2 and eosinophilia, 1 an increase of the number of platelets, 1 an increase of the hemoglobin rate pro erythrocyte (the same patient could have some side-effects). Hematological disturbances were more frequent ( p < 0.01) in the young age group (<40 years) if the patients were treated with clozapine alone, and more frequent ( p < 0.01) in the group above 40 years if clozapine was combined with other major tranquilizers and other psychotropic drugs.