The Effect of Sudden Clozapine Discontinuation on Management of Schizophrenic Patients: A Retrospective Controlled Study.

Background: The aims of our study were (1) tocompare the dose of clozapine needed to achieve remission inpatients who stopped their treatment (study group) versuspatients who continued taking this medication (control group) and(2) to compare the clinical characteristics of remission betweenthese 2 groups.

Method: We retrospectively reviewed the medicalrecords of all treatment-resistant schizophrenic andschizoaffective patients (according to DSM-IV criteria) who weretreated with clozapine over a period of 9 years, from January1995 through December 2003. The study group consisted of 43patients and the control group of 12 patients. All patients’files from both groups were examined, and each patient’sremission was scored twice initially on discharge from thehospital and subsequently after final discharge for the studygroup, or at the end of the study for the control group.

Results: The change of clozapine dose from thefirst to the last remission expressed by percentage shows asignificant difference between the 43% increase in clozapine dosein the study group and the 12.5% decrease in clozapine dose inthe control group (p < .001). Quality of remission assessmentshowed deterioration in the global remission score in the studygroup, while the quality of remission assessment in the controlgroup did not show any change.

Conclusions: Our findings suggest that thediscontinuation of clozapine treatment leads to a deteriorationin the quality of remission, with a need for an increased dose ofclozapine. Further prospective studies on larger samples areneeded to confirm these findings.