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Acute Schizophrenia and Schizoaffective Disorder | Treatment-Refractory Schizophrenia | Hostile and Aggressive Behavior in Schizophrenia | Schizophrenia Patients at High Risk for Suicide | Schizophrenia With Comorbid Substance Abuse | Supplemental Antipsychotic Treatment in Partial Responders
to Clozapine | Maintenance Therapy in Schizophrenia | Mania in Bipolar Disorder | Depression With Psychotic Features | Psychosis in Parkinson's Disease | Schizophrenia in Children and Adolescents
Excerpt
Because of its side-effect profile, clozapine is the only available
antipsychotic that should not be administered as a first-line agent
for schizophrenia or schizoaffective disorder. However, this does
not mean that clozapine is ineffective in these disorders. Early
trials comparing clozapine with haloperidol and chlorpromazine indicated
that clozapine was at least as effective as the other agents for acutely
psychotic patients. In the chlorpromazine comparison (Fischer-Cornelssen and Ferner 1976), the advantages were most apparent for the
more severely ill patients. The comparison with haloperidol (Honigfeld et al. 1984) was carried out in a more severely ill group
of patients and found a substantial advantage for clozapine. A report
by Shopsin et al. (1979) compared clozapine, chlorpromazine,
and placebo in 31 newly admitted patients with acute illness. Clozapine
was found to be superior to both chlorpromazine and placebo. Taken
together, these early studies indicate that clozapine is effective
for treatment of a broad range of individuals with acute psychosis. In
China, for example, clozapine is commonly prescribed as a first-line
antipsychotic for acute schizophrenia.