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Positive And Negative Symptoms Covary During Clozapine Treatment In Schizophrenia Positive And Negative  Symptoms Covary During Clozapine Treatment In Schizophrenia

Clozapine is an atypical antipsychotic agent with a unique therapeutic profile: in contrast to conventional neuroleptics, clozapine is more effective in decreasing positive and negative symptoms in treatment-refractory schizophrenic patients and causes fewer extrapyramidal side-effects (EPS) and tardive dyskinesia. It has been found to produce greater improvement in negative symptoms than typical neuroleptics. Meltzer (1990, 1991) observed that negative symptoms improved independently of change in positive symptoms in schizophrenic patients treated with clozapine; he noted that clozapine differed from conventional neuroleptics in this regard. The question of whether the observed greater efficacy of clozapine in treating negative symptoms is related to its greater efficacy in treating positive symptoms in this population of schizophrenic patients or whether the clozapine-associated reduction in negative symptoms occurs independently of such improvement has obvious pathophysiological
and clinical importance. To study this question, we assessed positive and negative symptoms in a sample of 40 schizophrenic patients before and about 8 weeks after
an open clinical trial of clozapine.

Results

Results Both positive and negative symptoms improved significantly (p < .01) with clozapine treatment (Table 1). Use of the BPRS “ANER” factor (emotional withdrawal, motor retardation, and blunted affect) instead of the SANS sum of global scores to define negative symptoms did not alter the findings. Change in negative symptoms was significantly correlated to change in positive symptoms (Fig. 1).
TABLE 1 OF Positive And Negative Symptoms Covary During Clozapine Treatment In Schizophrenia

Figure 1. Change in negative symptoms was significantly correlated to change in positive symptoms
Figure 1. Change in negative symptoms was significantly correlated to change in positive symptoms

Conclusion

These  data  indicate  that clozapine  is similar  to typical  neuroleptics  with regard  to improvement  in negative  symptoms  and their covariance  with positive symptoms.  In com-parison to typical neuroleptics,  the apparent  greater efficacy of clozapine  in treating  negative symptoms  may be related to its greater efficacy in treating  positive symptoms  in treatment-refractory  patients  and its lower propensity  to cause EPS.
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