Years Of Schizophrenia Research Articles

Relapse prevention with cariprazine in patients with early-stage schizophrenia

IntroductionRelapse is defined as the return of psychotic symptoms after a period of improvement/stability. Relapse is often associated with the disruptive re-hospitalization of patients. Importantly, relapse history is a strong predictor of subsequent relapses and poorer outcomes. Therefore, relapse prevention in the beginning of the disorder is especially important. Cariprazine, a novel D3-D2 partial agonist, has been effective in preventing relapse compared to placebo in stabilized patients with schizophrenia.ObjectivesTo present the efficacy of cariprazine in preventing relapse in patients with early-stage schizophrenia.MethodsPost-hoc analysis of data from a ˜96 weeks, multicentre, randomized, double-blind, placebo-controlled, parallel-group study in adults with schizophrenia. The study was composed of two parts: a 20-week open-label treatment phase and a double-blind treatment phase up to 72 weeks. During the open-label phase, patients were stabilized with cariprazine 3.0-9.0 mg/day. Then, they were randomized to continue cariprazine (fixed dosing: 3.0, 6.0, or 9.0 mg/day) or receive placebo. Relapse was defined as a deterioration of symptom scores as measured by the Positive Negative Syndrome Scale (PANSS), admission to a psychiatric hospital, exhibiting aggressive behaviour, or risk of suicide. In the present analysis, patients with a schizophrenia diagnosis history of 0-5 years were defined as early-stage patients. Baseline characteristics, and risk ratios (after the double-blind phase) with number-needed-to-treat (NNT) were calculated.ResultsOf 200 patients, 71 (35.5%) met the early-stage criteria: 32 patients in the cariprazine (CAR) and 39 in the placebo (PBO) arm. The mean age was 31.6 years in both groups with an average illness duration of 2.51+/-1.03 years in the CAR and 2.75+/-1.24 years in the PBO arm. 47% of patients in the CAR arm and 77% in the PBO arm were men. The average number of previous hospitalisations was comparable in the two groups (CAR: 2.3; PBO: 2.6), as was the severity of illness: mean PANSS Total score: 89.2 (CAR), 90.4 (PBO). Patients in both groups were highly compliant (pill-count: CAR: 98.2%; PBO: 99.5%). The main reported adverse effects were headache (CAR: 11.3%, PBO: 7.0%), insomnia (CAR: 5.6%, PBO: 4.2%), and increased triglycerides (CAR: 5.6%, PBO: 1.4%), discontinuation due to adverse event was 3.1% in the CAR and 2.6% in the PBO group. Altogether, 9.4% of patients relapsed in the cariprazine group compared to 48.7% on placebo (risk ratio=0.19 (95% confidence interval (CI): 6.3-59.2%, p=0.0041;NNT: 2.5 (95%CI: 1.7-5.1).ConclusionsIn this post-hoc analysis of patients within the first five years of schizophrenia, the relative risk of relapse was 81% reduced with cariprazine with prevention of one additional relapse after each third patient exposed to cariprazine vs placebo. Cariprazine seems to be a good treatment option for early-stage patients for preventing relapse.Disclosure of InterestC. Correll Consultant of: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Biogen, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Denovo, Gedeon Richter, Hikma, Holmusk, IntraCellularTherapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Neurelis, Newron, Noven, Novo Nordisk, Otsuka, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, SK Life Science, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Takeda, Teva, Tolmar, Vertex, and Viatris., Z. Dombi Employee of: Gedeon Richter Plc., P. Herman Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.

The Role of Religion and Ethnic Factors in My Recovery From 10 Years of Schizophrenia and Severe Depression.

The Role of Religion and Ethnic Factors in My Recovery From 10 Years of Schizophrenia and Severe Depression.

Single trajectory treatment response for predominant negative symptoms: Post-hoc analysis of a clinical trial with cariprazine and risperidone.

Examining the heterogeneity of negative symptoms of schizophrenia contributes to the identification of available treatment targets. Generally, prior evidence classified three to four symptom treatment response trajectory groups over the course of positive symptoms, yet, no evidence exists regarding the heterogeneity of medium-term response to predominant negative symptoms. The current post-hoc analysis aims to identify the heterogeneity in negative symptom treatment response trajectories among patients with predominant negative symptoms who received either cariprazine or risperidone for 26weeks. Treatment response was analyzed based on the: the Positive and Negative Syndrome Scale Factor Score for Negative Symptoms (PANSS-FSNS), and the Clinical Global Impression Severity (CGIS) and Improvement (CGII) scales. To identify subgroups of patients with a similar course of treatment response, group-based trajectory modelling was utilized. Results demonstrated that in comparison with competing models, a single trajectory best described the treatment response of patients with predominant negative symptoms. The results indicate that patients with predominant negative symptoms with over ten years of schizophrenia respond rapidly to adequate treatment and follow a course of steady improvement.

Antecedents to first episode psychosis and mania: Comparing the initial prodromes of schizophrenia and bipolar disorder in a retrospective population cohort

ObjectiveWe aim to compare the psychiatric antecedents of schizophrenia (SZ) and bipolar disorder (BD). MethodsUsing the Rochester Epidemiology Project, we searched for residents of Olmsted County that had a diagnosis of SZ or BD. We confirmed each case using DSM-5 criteria and obtained the psychiatric antecedents. ResultsWe identified 205 cases with first episode psychosis or mania (SZ = 131; BD = 74). The mean age at first visit for mental health reasons was 12.3 ± 6.3 years for SZ and 13.9 ± 5.6 years for BD. The duration of the initial prodrome (time from first mental health visit to first episode) was similar for both groups (SZ 8.3 ± 6.2 years vs BD 7.3 ± 5.9 years). We found that SZ and BD have overlapping antecedents, but SZ was more common in males and in foreign born and had more learning deficits before the first episode. BD was more common in white population and had higher rates of depressive and adjustment disorders prior to first episode. BD also had more affective symptoms, nightmares, and panic attacks before the first episode. Both groups had similarly high rates of substance use (SZ 74 % vs BD 74.3 %), prescription of antidepressants (SZ 46.6 % vs BD 55.4 %) and stimulants (SZ 30.5 % vs BD 22.9 %). ConclusionsThe psychiatric antecedents of SZ and BD usually start during adolescence, overlap, and present in unspecific ways. The initial prodromes are more alike than distinct. Further studies are encouraged to continue looking for specific factors that distinguish the antecedents of these two disorders.

Second Generation Long-Acting Injectable Antipsychotics in Africa: About a Case

Introduction Schizophrenia affects people worldwide. In Europe, the advantages of second-generation and long-acting injectable antipsychotics (SG-LAIs) are known and used, supported by scientific evidence. However, somewhere there is limited evidence on this topic.ObjectivesHighlight the improvements in antipsychotic treatment and raise awareness of the scar between Europe and Africa, showing the results of the evidence with a case of cooperation with Cameroon.MethodsAbout a case of a 42-year-old Cameroonian woman with 25 years of schizophrenia, treated with first-generation antipsychotic polypharmacy (APP) oral and depot, with several psychotic relapses, disorganized behaviors, motor and cognitive impairment and isolation (telemedicine consultation received through a NGO platform).A search on PubMed was performed, selecting two systematic reviews including “antipsychotic” AND “Africa”, one systematic review for SGAs and four reviews for LAIs.ResultsSeven articles were reviewed, finding that APP use is highly prevalent in Africa with a lack of research on this, SGAs show an improved safety and tolerability profile and LAIs are among the most effective treatments in psychiatry improving adherence and overall patient outcomes.In our case, we recommend progressively adjusting treatment to SG-LAI monotherapy, visiting the patient six months later in Cameroon, observing sustained stability of positive symptoms with an improvement of negative symptoms and good adherence and tolerability to treatment without extrapyramidal effects.ConclusionsOur case is an example of the evidence that supports the improvement that SG-LAIs represent in psychiatric treatment and how international cooperation can help bridge the gap between Africa and Europe. Nevertheless, more research is needed to build bridges.Disclosure of InterestNone Declared

Olanzapine-Associated Thrombocytopenia: A Case Report and Review of the Literature

Olanzapine is an atypical antipsychotic with proven efficacy in the treatment of schizophrenia and bipolar disorder. This molecule is known for its metabolic side effects, but it is considered the safest with regard to haematological toxicity. The case of our 28 year old patient, who has been followed anarchically for 5 years for schizophrenia and who presented a thrombocytopenia of 99,000/mm3 within a week of being put on olanzapine without any other associated signs, is one of nine cases published in the literature illustrating this association which is rare but encourages clinicians to institute close haematological monitoring to prevent any life threatening effects.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population

ObjectiveThere is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. MethodsNaturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. ResultsPatients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. ConclusionsThe results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

Elevated brain-derived cell-free DNA among patients with first psychotic episode - a proof-of-concept study.

Schizophrenia is a common, severe, and debilitating psychiatric disorder. Despite extensive research there is as yet no biological marker that can aid in its diagnosis and course prediction. This precludes early detection and intervention. Imaging studies suggest brain volume loss around the onset and over the first few years of schizophrenia, and apoptosis has been proposed as the underlying mechanism. Cell-free DNA (cfDNA) fragments are released into the bloodstream following cell death. Tissue-specific methylation patterns allow the identification of the tissue origins of cfDNA. We developed a cocktail of brain-specific DNA methylation markers, and used it to assess the presence of brain-derived cfDNA in the plasma of patients with a first psychotic episode. We detected significantly elevated neuron- (p=0.0013), astrocyte- (p=0.0016), oligodendrocyte- (p=0.0129), and whole brain-derived (p=0.0012) cfDNA in the plasma of patients during their first psychotic episode (n=29), compared with healthy controls (n=31). Increased cfDNA levels were not correlated with psychotropic medications use. Area under the curve (AUC) was 0.77, with 65% sensitivity at 90% specificity in patients with a psychotic episode. Potential interpretations of these findings include increased brain cell death, disruption of the blood-brain barrier, or a defect in clearance of material from dying brain cells. Brain-specific cfDNA methylation markers can potentially assist early detection and monitoring of schizophrenia and thus allow early intervention and adequate therapy.

The efficacy of cariprazine in chronic schizophrenia – post hoc analyses of phase II/III clinical trials

IntroductionChronic schizophrenia patients are experiencing persistent and severe illness for more than 15-20 years and are usually suffering from long-term negative symptoms. Cariprazine, a novel D3-D2 partial agonist has been proven to be effective in the treatment of acute schizophrenia, however its ability to treat chronic patients has not been assessed yet.ObjectivesThe primary aim of the present post-hoc analysis is to assess the efficacy of cariprazine in treating patients with chronic schizophrenia (late-stage and residual schizophrenia patients).MethodsData from 3 phase II/III 6-week, randomized, double-blind, placebo-controlled trials with similar design in patients with acute exacerbation of schizophrenia were pooled and patients with more than 15 years of schizophrenia were analysed (late-stage patients). Furthermore, schizophrenia patients experiencing predominantly negative symptoms from a 26-week, randomized, double-blind, active-controlled, fixed-flexible-dose trial with an ICD-10 code of F20.5 were analysed post-hoc (residual patients).ResultsAltogether, 414 late stage (286 cariprazine and 128 placebo) and 35 residual (23 cariprazine and 12 risperidone) patients were identified. The pooled analysis evaluating mean change from baseline to week 6 in the PANSS total score indicated statistically significant difference in favour of cariprazine in the late stage (LSMD -6.7, p<0.01) subpopulation compared to placebo. The mean change from baseline in patients with residual schizophrenia in the cariprazine arm was -9.6 on the PANSS-FSNS scale, while -7.9 in the risperidone arm.ConclusionsBased on the results, it seems that cariprazine might be a good treatment option for patients with chronic schizophrenia. Nonetheless, further studies are needed to confirm this.DisclosureI am an employee of Gedeon Richter Plc.

Ischemic colitis related to antipsychotics : A rare and serious entity to know

IntroductionIschemic colitis is a rare condition. It represents 3 to 10% of lower digestive hemorrhages. It preferentially affects the subject over the age of 50 with predisposing factors. Rare cases have been reported in young subjects with the use of cocaine, combined hormones or antipsychotics.ObjectivesThis work aimed to study the potential side effects of antipsychoticsMethodsWe report a case of ischemic colitis associated with antipsychotics.ResultsA 27-year-old patient, followed for 2 years for schizophrenia treated with antipsychotics (chlorpromazine and haloperidol) and an antiparkinsonian (Biperiden), consulted in the emergency room for rectorragies progressing for 3 days. The examination revealed the installation of diffuse abdominal pain associated with early postprandial vomiting which preceded the 7-day rectal bleeding. The physical examination revealed ascites without edema of the lower extremities. The stools were normal-colored on digital rectal examination. The biological workup revealed anemia and a biological inflammatory syndrome. The abdomino-pelvic scanner showed thickening of the entire colonic wall with signs of recent bleeding. The rectosigmoidoscopy showed an ecchymotic aspect of the sigmoid with less pronounced involvement of the rectum. Pathologic examination of the colonic biopsies concluded with ischemic colitis, showing hemorrhagic suffisions with numerous fibrinous thrombi of the vessels. The course was marked by the onset of multi-organ failure with acute renal failure, a picture of disseminated intravascular coagulation (DIC) and alveolar hemorrhage. Despite the resuscitation, the patient died 2 days after admission.ConclusionsIschemic colitis is a rare side effect of antipsychotics. Although rare, this entity should be evoked and diagnosed in time.DisclosureNo significant relationships.

ACUTE PSYCHOSIS AND RHABDOMYOLYSIS IN THE FACE OF HYPOTHYROIDISM

Myxedematous psychosis was first described in 1979 by Pr Asher, it is a rare diagnosis associating an acute psychosis, a rhabdomyolysis whose etiology is hypothyroidism. We report the case of a 32-year-old patient followed for 6 years for schizophrenia, who had not had any treatment for 3 years, and was admitted with an acute psychotic attack consisting of delusions of persecution. The examination revealed an oedematose syndrome, deep hypothyroidism, and high creatine phosphokinase. The treatment was the correction of the hypothyroidism associated with a short psychogenic treatment with a favorable evolution after 1 month of treatment with regression of the psychiatric picture.

Temporal Trends in the Incidence and Disability Adjusted Life Years of Schizophrenia in China Over 30 Years.

BackgroundSchizophrenia is an important public health problem in China. This study aims to assess the long-term trends in the incidence and disability-adjusted life years (DALYs) rate of schizophrenia in China between 1990 and 2019.MethodsThe incidence and DALYs data were drawn from the Global Burden of Disease Study 2019, and an age–period–cohort model was used in the analysis.ResultsThe age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) of schizophrenia increased by 0.3 and 3.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 10 to 29 years (local drifts, 0.01 to 0.26%) and lower than 0 (P < 0.05) in those aged 35 to 74 years (local drifts, −1.01 to −0.06%). For females, the local drift was higher than 0 (P < 0.05) in those aged 10 to 34 years (local drifts, 0.05 to 0.26%) and lower than 0 (P < 0.05) in those aged 40 to 74 years (local drifts, −0.86 to −0.11%). The local drift for DALYs rate was higher than 0 (P < 0.05) in the age group from 10 to 69 years (local drifts, 0.06 to 0.26% for males and 0.06 to 0.28% for females). The estimated period and cohort relative risks (RR) for DALYs rate of schizophrenia were found in monotonic upward patterns, and the cohort RR for the incidence increased as the birth cohort moved forward starting with those born in 1972.ConclusionAlthough the crude incidence of schizophrenia has decreased in China, the ASIR, ASDR, and crude DALYs rate all showed a general increasing trend over the last three decades. The DALYs rate continue to increase as the birth cohort moved forward, and the increasing trend of incidence was also found in individuals born after 1972. More efforts are needed to promote mental health in China.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population

ObjectiveThere is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. MethodsNaturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. ResultsPatients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. ConclusionsThe results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

Invited commentary from a LAMIC country: Thirty-five years of schizophrenia - the Madras Longitudinal study

Invited commentary from a LAMIC country: Thirty-five years of schizophrenia - the Madras Longitudinal study

Predicting real-world functioning in outpatients with schizophrenia: Role of inflammation and psychopathology

Several studies indicate that negative and cognitive symptoms are determining factors of functioning in patients with schizophrenia. However, they do not usually include biological aspects, such as inflammatory markers. The current prospective study aims to identify clinical and biological factors predicting real-world functioning, at baseline and at one-year follow-up, of outpatients in an early stage of schizophrenia. Sample consist of 73 clinically stable patients with schizophrenia, of which 57 completed the one-year follow-up. Accurate psychopathology, functioning, and cognitive assessments were performed at baseline and follow-up (Positive and Negative Syndrome, Brief Negative Symptom, Calgary Depression, Personal and Social Performance Scales, and MATRICS Cognitive Consensus Battery). Biological biomarkers including anthropometric data and blood parameters were collected. Pearson correlation and multiple regression analyses including potential confounding factors were performed. Negative symptoms (especially asociality and avolition), along with the inflammatory biomarker interleukin-2, are the most important determining factors of poor real-world functioning in early-stage schizophrenia. The previous functioning, along with baseline cognitive performance in attention and vigilance, predicts functioning at one-year follow-up in these patients. Strategies aimed at improving negative and cognitive symptoms, as well as modifying certain inflammatory pathways, should be the targets to achieve functional recovery in the first years of schizophrenia.

Machine learning for predicting psychotic relapse at 2 years in schizophrenia in the national FACE-SZ cohort

BackgroundPredicting psychotic relapse is one of the major challenges in the daily care of schizophrenia. ObjectivesTo determine the predictors of psychotic relapse and follow-up withdrawal in a non-selected national sample of stabilized community-dwelling SZ subjects with a machine learning approach. MethodsParticipants were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and received a thorough clinical and cognitive assessment, including recording of current treatment. Relapse was defined by at least one acute psychotic episode of at least 7 days, reported by the patient, her/his relatives or by the treating psychiatrist, within the 2-year follow-up. A classification and regression tree (CART) was used to construct a predictive decision tree of relapse and follow-up withdrawal. ResultsOverall, 549 patients were evaluated in the expert centers at baseline and 315 (57.4%) (mean age = 32.6 years, 24% female gender) were followed-up at 2 years.On the 315 patients who received a visit at 2 years, 125(39.7%) patients had experienced psychotic relapse at least once within the 2 years of follow-up. High anger (Buss&Perry subscore), high physical aggressiveness (Buss&Perry scale subscore), high lifetime number of hospitalization in psychiatry, low education level, and high positive symptomatology at baseline (PANSS positive subscore) were found to be the best predictors of relapse at 2 years, with a percentage of correct prediction of 63.8%, sensitivity 71.0% and specificity 44.8%.High PANSS excited score, illness duration <2 years, low Buss&Perry hostility score, high CTQ score, low premorbid IQ and low medication adherence (BARS) score were found to be the best predictors of follow-up withdrawal with a percentage of correct prediction of 52.4%, sensitivity 62%, specificity 38.7%. ConclusionMachine learning can help constructing predictive score. In the present sample, aggressiveness appears to be a good early warning sign of psychotic relapse and follow-up withdrawal and should be systematically assessed in SZ subjects. The other above-mentioned clinical variables may help clinicians to improve the prediction of psychotic relapse at 2 years.

Successful hearing improvement with direct acoustic stimulation in a patient with schizophrenia

A direct acoustic cochlear implant provides its power directly to the inner ear by vibrating the perilymph via a conventional stapes prosthesis. Our experience with a patient with severe mixed hearing loss due to otosclerosis is described.Case reportThe patient, a 47-year-old male, had a pre-operative speech recognition score of 10 per cent and had been treated for many years for schizophrenia, both of which made him a poor candidate for a direct acoustic stimulation device. Nevertheless, the surgery was performed, which preserved the pre-operative bone conduction level and significantly improved hearing. His speech recognition score rose to 100 per cent. He uses the device all day and his auditory hallucinations have subsided. Improvement of schizophrenia symptoms has enabled the patient to reduce his psychiatric medications intake. Hearing restoration was the main reason for the reduction of auditory hallucinations in our patient. Hearing loss is a potentially reversible risk factor for psychosis, but this association is often overlooked.

Elevated C-reactive protein as a predictor of a random one-year clinical course in the first ten years of schizophrenia

We investigate whether C-reactive protein (CRP) levels could predict the clinical course of patients with schizophrenia in a prospective study of 50 stable outpatients during a random 1-year period within the first 10 years of illness. Positive, negative, depressive, and cognitive symptoms were evaluated. Patients with low-grade inflammation (CRP = 3–10 mg/L; 28%) at baseline showed significant worsening of PANSS-positive and general psychopathology at 1-year follow-up compared with those with CRP ≤ 3 mg/L. Elevated CRP may be a biomarker of poor 1-year clinical course in patients with schizophrenia.

Oxidative stress biomarkers and clinical dimensions in first 10 years of schizophrenia

IntroductionSeveral studies have described increased oxidative stress parameters in patients with schizophrenia. The objectives of the current study were to identify potential oxidative stress biomarkers in stable patients during first 10 years of schizophrenia and determine if they are associated with specific clinical dimensions. Material and methodsSeventy-three clinically stable outpatients with schizophrenia and 73 sex and age-matched healthy controls were recruited. Sociodemographic, clinical and biological data were collected at enrollment. Blood biomarkers included homocysteine, the percentage of hemolysis, lipid peroxidation subproducts, and as an antioxidant biomarker, catalase activity in erythrocytes. ResultsComparative analyses after controlling for smoking and metabolic syndrome evidenced a significant increase in catalase activity in patients. Also, lower lipid peroxidation levels showed an association with negative symptoms. ConclusionsIn conclusion, compensatory antioxidant mechanisms might be increased in stable patients with schizophrenia at early stages. Furthermore, there may be an inverse relationship between oxidative stress and negative dimension.

Alterations in oxidative stress markers and its correlation with clinical findings in schizophrenic patients consuming perphenazine, clozapine and risperidone

Background and ObjectiveToday, the role of oxidative stress in development of schizophrenia has gained attention. Also, some atypical antipsychotic agents showed antioxidant properties. Therefore, in this study, we evaluated the level of oxidative stress parameters between patients treated with perphenazine, clozapine and risperidone and their relationship with schizophrenia symptoms’ severity. Materials and MethodsThis was a descriptive study on 100 patients with chronic schizophrenia. Patient selection was done based on the DSM-IV-TR criteria for at least 3 months regular use of clozapine or risperidone or perphenazine and a minimum period of 2 years of schizophrenia. Ten ml of patient’s blood samples were used to assess serum levels of glutathione (GSH), protein carbonyl, lipid peroxidation (LPO), superoxide dismutase (SOD) and Ferric Reducing Ability of Plasma (FRAP). Also, the severity of symptoms was assessed with the positive and negative syndrome scale (PANSS scale). P-values of less than 0.05 were considered significant. ResultsThe results showed a significant difference between clozapine and risperidone with perphenazine in all subscales of PANSS. Also, there was a positive correlation between MDA and PANSS all subscales in risperidone and perphenazine groups and a negative correlation between MDA and PANSS in all subscales in the clozapine group. Serum level of GSH and negative symptoms in patients receiving clozapine showed a negative correlation. The results also represented that clozapine significantly increased SOD levels in comparison to perphenazine and risperidone and reduced LPO in comparison to perphenazine and risperidone, While the protein carbonyl level did not show a significant difference between three groups (p-value = 0.8). ConclusionThis study showed that clozapine, as an atypical antipsychotic agent, has significant antioxidant effects compared to risperidone and perphenazine. Especially, it increased SOD and GSH levels and reduced LPO in patients with schizophrenia. Therefore, clozapine’s antioxidant effect may be contributive to improving negative symptoms of schizophrenic patients.