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Objective: Treatment-resistant schizophrenia is observed in %15-20 of all cases. It is an important and difficult issue for clinicans and patients as it causes occupational and social problems. It is known that patients have to stay in hospital and severe and high dose medicine cause complication. Many drugs have been used in the treatment of resistant cases, but clozapine has also been shown to provide the best results. Clozapine is still the gold standart in these cases. In schizophrenia dominance of positive symptoms in the clinical interest causes the neglect of negative symptoms. Criteria for treatment-resistance schizophrenia although more positive symptoms are established by considering, nowadays the negative symptoms are more heeded and attracting more attention. Aim of this study is to determine the efficacy of clozapine in treatment resistant schizophrenia over both positive and negative symptoms.
Method: Schizophrenia patients who were taking two or more treatment trials of at least two groups of conventional antipsychotics for at least 4-6 weeks, and had no response to treatment, have been evaluated. A total of 60 cases, 40 male and 20 female were accepted. The average age of male patients was 36,3 and female patients was 35,1. SCID, Scales for the assessment of positive symptoms (SAPS) and scales for the assessment of negative symptoms (SANS) have been used just before switching to clozapine treatment and after clozapine treatment. Electroconvulsive therapy has been used in combination with clozapine to the clozapine-resistant patients.
Results: Proportion of respondents to clozapine treatment was found %93,3 (n=56). The rate of clozapine resistant schizophrenia patients was found %7,6 (n=4). According to the SAPS scores %62,6 percent reduction in positive symptoms and according to the SANS scores %42,9 percent reduction in negative symptoms were achieved. Scale for the assessment of positive symptoms in hallucinations section expect olfactory hallucinations, in delusion section expect thought withdrawal, in bizarre behavior section and in positive formal thought disorder section expect clanging were statistically significantly decreased. Scale for the assessment of negative symptoms in all sections (affective şattening or blunting, alogia, avolition/apathy, anhedonia/asociality, attention) was statistically significantly decreased.
Conclusion: Clozapine has been found effective on both positive and negative symptoms of treatment-resistant schizophrenia. While conventional antipsychotics have limited effect on negative symptoms, clozapine provides an effective improvement in these symptoms. The most important reason for the lack of effect is persistent negative symptoms for patients with schizophrenia and use of clozapine in treatment-resistant schizophrenia becomes more important.