Wednesday, February 20, 2008

Schizophrenia Drug’s Dosage Drives Success

The Vanderbilt physician who in the late 1980s established the antipsychotic drug clozapine as the gold standard for treating patients with treatment-resistant schizophrenia has improved on his own research.

Herbert Meltzer, M.D., director of the Schizophrenia Program in the Department of Psychiatry, and colleagues have shown that the success of clozapine in treating this population was not due to the unique pharmacologic features of the drug itself, but the fact that it was used at higher doses than what is used to treat patients with schizophrenia who respond well to antipsychotic drugs. Clozapine is rarely used for the 70 percent of patients whose psychotic symptoms respond well to a wide array of other antipsychotic drugs.

The study, published in the Jan. 23 issue of The Journal of Clinical Psychiatry and funded by Eli Lilly, included 40 men and women, ages 18 to 58, diagnosed with schizophrenia or schizoaffective disorder, which many think is part of the same spectrum of illness. Patients were recruited from three U.S. outpatient community mental health treatment facilities, including Nashville's Centerstone Mental Health Center.

The results showed that the drug olanzapine, whose pharmacology is considered closer to clozapine than that of any other drug available, when used at a higher dose than the established norm, is as effective as clozapine in improving psychopathology and cognition in treatment-resistant patients. The study showed that treatment-resistant patients taking higher doses respond more slowly than average patients taking conventional doses. In fact, both need to be given for six months before a good treatment response occurs, compared to six weeks for the average patient at the lower dose range.

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