Psychotic Disorders by Oliver Freudenreich

Author:Oliver Freudenreich
Language: eng
Format: epub
ISBN: 9783030294502
Publisher: Springer International Publishing

Efficacy for Refractory Psychosis

Clozapine is the most effective intervention for psychosis (other than ECT) that we have in our armamentarium. In the seminal study by Kane and colleagues [7], clozapine led to some improvement in 30% of patients who were prospectively treated with at least two antipsychotics (at the time, first-generation antipsychotics) and judged refractory. The superiority of clozapine has since been confirmed in several other trials, including in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) cohort which included patients who had failed second-generation antipsychotics [8]. In younger, first-episode patients, up to 75% may benefit from a switch to clozapine [9]. In more chronic populations, fewer patients will benefit, probably about 50% [10]. At least two meta-analyses [11, 12] confirm the clinical impression that clozapine is a different drug that can be helpful for those patients who respond poorly to other antipsychotics. One analysis estimated that 40% of patients have a clinically meaningful response to clozapine, with an average symptom reduction of 25% [13]. I suspect that part of its effectiveness is not based on pharmacology alone but stems from the need to provide good psychiatric care, with close and regular clinical follow-up of patients.

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