Clozapine for schizophrenia - Clinical effect, financial considerations, and quality requirements

Twenty-six years ago at Sanderud Hospital we started treating schizophrenic patients with clozapine (Leponex(R)). This treatment has led to a better life for many schizophrenic patients and represents a breakthrough in regard to the quality of their remaining years. Between 1973 and 1995, 103 schizophrenic patients were given clozapine treatment on a trial basis. The patients had long medical histories. We observed considerable improvement after up to 3 years' treatment with regard to both clearly positive psychotic symptoms and negative symptoms such as social withdrawal and isolation. There were few and very short-lasting re-hospitalizations. After 3 years 64 patients were living at home. Those patients who are still in institutions are being treated in open wards, psychiatric care centres, or communal nursing homes. Drowsiness and "too much saliva" were the commonest side effects. One patient developed agranulocytosis but survived. Two developed leucopenia. Abrupt self-termination of treatment quickly leads to relapse and may have severe consequences. None of our patients committed suicide. All the patients had extrapyramidal side effects before starting clozapine therapy. These side effects disappeared, and clozapine itself did not cause extrapyramidal side effects. Treatment with clozapine is clearly cost-effective. The study is a naturalistic one, registering the effect of treatment with clozapine, but changes in practice over the years since 1973 must be taken into consideration.