clozapine and fluphenazine-depot

To compare patient's attitudes, demographic, clinical characteristics, psychopathology, insight and type of antipsychotic therapy in compliant and non-compliant outpatients with schizophrenia; to explore correlations between patient's attitudes and related variables.. A sample of 44 outpatients of both genders (> 60 years), with a diagnosis of ICD-10 Schizophrenia (F20) was included into the study. All the patients were on maintenance treatment with different classes of antipsychotics (oral, depot or both), for at least 6 months from the latest hospitalisation. The exclusion criteria were determined. The BPRS and the PANSS were used to assess psychopathology and insight (G12 item). The self-report questionnaire MARS was used to assess patient's attitudes.. Compliant patients (N=37) showed the following significant differences compared to non-compliant patients (N=7): higher the MARS (p<0.001), lower the PANSS (Positive sub score) (p<0.01) G12 scores (p<0.01) (the Student t test) and percentage of patients with previous non-compliance (p<0.05) (chi2 test). Considerable correlation between the MARS and the BPRS (p<0.001), the PANSS (Positive, General psychopathology) (p<0.001; p<0.01), G12 scores (p<0.05) (negative) and current compliance (p<0.001) was also found (The Spearman's correlation).. Our results suggest that special attention should be paid to attitudes, severity of psychopathology, insight and history of non-compliance in compliance evaluation of outpatients with schizophrenia.

Topics: Administration, Oral; Adult; Age Factors; Ambulatory Care; Antipsychotic Agents; Clozapine; Cross-Sectional Studies; Delayed-Action Preparations; Female; Fluphenazine; Haloperidol; Health Knowledge, Attitudes, Practice; Humans; Long-Term Care; Male; Middle Aged; Patient Compliance; Psychiatric Status Rating Scales; Risperidone; Schizophrenia; Schizophrenic Psychology; Yugoslavia

Topics: Adult; Antipsychotic Agents; Blood Glucose; Body Mass Index; Clozapine; Diabetes Mellitus, Type 2; Dibenzothiazepines; Diet, Diabetic; Drug Therapy, Combination; Female; Fluphenazine; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Male; Mass Screening; Quetiapine Fumarate; Risk Factors; Schizophrenia

We describe the case of a 39-year-old patient with schizophrenia who developed worsening of glucose metabolism during treatment with two different atypical antipsychotics, clozapine and quetiapine. Diabetes mellitus was recognized during clozapine treatment. During quetiapine treatment, while patient was taking diabetic diet, fasting and 1-hour glucose levels and body mass index, decreased, but 2-hour glucose levels increased. This suggests that, in some patients, monitoring of only fasting glucose level and body mass index may be insufficient for detecting the glucose metabolism abnormalities. In those patients oral glucose tolerance test may be recommended. Recommendations about when and how often clinicians should administer the test do not exist in current guidelines. Further studies are needed for the elucidation of this question.

Topics: Adult; Antipsychotic Agents; Clozapine; Drug Therapy, Combination; Fluphenazine; Glucose Tolerance Test; Humans; Male; Schizophrenia; Weight Gain

Topics: Adult; Antipsychotic Agents; Clozapine; Drug Administration Schedule; Dyskinesia, Drug-Induced; Female; Fluphenazine; Haloperidol; Humans; Longitudinal Studies; Schizophrenia, Paranoid

Decreasing hospital admissions is important for improving outcomes for people with schizophrenia. Second-generation antipsychotics (SGAs) are better tolerated for long-term therapy than traditional medications and may contribute to a lower rehospitalization risk, but have not been compared to depot forms with regard to long-term outcomes. This study evaluates the risk of readmission in patients discharged from six State of Maryland inpatient mental health facilities between Jan. 1, 1997 and Dec. 31, 1997 on clozapine (N = 41), risperidone (N = 149), and olanzapine (N = 103). These patients were compared with those discharged from the two largest state facilities during the same time period on fluphenazine decanoate (N = 59) or haloperidol decanoate (N = 59). One-year readmission risk (measured by Kaplan-Meier survival analysis with Holm's adjustment for multiple comparison on Log Rank tests) were 10% for clozapine, 12% for risperidone, and 13% for olanzapine. These risks were not significantly lower than the readmission risk for fluphenazine decanoate (21%) but were significantly lower than haloperidol decanoate (35%) for all three SGAs. Demographic and clinical variables did not predict readmission for any of the medications. In patients with similar demographic and clinical characteristics, 1-year risk of readmission for patients treated with SGAs were at least comparable to the 1-year risk for patients receiving fluphenazine decanoate and lower than the risk for patients treated with haloperidol decanoate. SGAs may provide better long-term prognoses and outcomes for patients with schizophrenia.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Data Collection; Delayed-Action Preparations; Female; Fluphenazine; Haloperidol; Humans; Male; Olanzapine; Patient Readmission; Pirenzepine; Risperidone; Schizophrenia; Secondary Prevention; Time Factors; Treatment Outcome

Clozapine, an atypical antipsychotic agent used in cases of treatment-resistant schizophrenia, is known for its relative absence of extrapyramidal side effects and its potential hazardous effect on white blood cell function. We have described a case of clozapine-associated epistaxis and reduction of the platelet count. Discontinuance of clozapine therapy resulted in cessation of epistaxis followed by normalization of the platelet count. We suggest routine monitoring of platelet count and function in patients treated with clozapine.

Topics: Amobarbital; Blood Cell Count; Clozapine; Delayed-Action Preparations; Diazepam; Drug Monitoring; Drug Therapy, Combination; Epistaxis; Fluphenazine; Hemoglobins; Humans; Male; Middle Aged; Platelet Count; Schizophrenia, Paranoid; Thrombocytopenia

Clozapine is an antipsychotic drug reported to be virtually free of extrapyramidal effects. On the basis of this, we hypothesized that it would be unlikely to cause the neuroleptic malignant syndrome (NMS), a rare but severe reaction observed with other antipsychotic drugs. However, when we administered clozapine (in conjunction with lithium) to a patient with a past history of NMS with fluphenazine, the syndrome reappeared after about 3 weeks of treatment. This represents, to our knowledge, the first report of apparent NMS with clozapine.

Topics: Adult; Bipolar Disorder; Clozapine; Dibenzazepines; Drug Therapy, Combination; Fluphenazine; Humans; Lithium; Lithium Carbonate; Male; Neuroleptic Malignant Syndrome

The results of treating 251 therapeutically resistant patients with paranoid schizophrenia by moditen-depo, its combination with other psychotic drugs or leponex was compared. The results obtained indicate that a comprehensive treatment (moditen-depo with other psychotropic drugs) and by leponex may be successfully applied to some of the paranoid schizophrenics resistant to moditen-depo and other neuroleptic drugs or their combinations. Comprehensive treatment appeared to be more effective in systematized delusions, the syndrome of psychic automatisms and in a crude emotional-volitional defect. Treatment by leponex was more efficacious in emotionally saturated nonsystematized delusions, pronounced disordered behaviour and mild manifestation of deterioration.

Topics: Adolescent; Adult; Antidepressive Agents; Antipsychotic Agents; Clozapine; Delayed-Action Preparations; Depression; Dibenzazepines; Drug Therapy, Combination; Female; Fluphenazine; Humans; Male; Middle Aged; Psychotropic Drugs; Remission, Spontaneous; Schizophrenia, Paranoid