Effects of Clozapine Therapy in Schizophrenic Individuals at Risk for Tardive Dyskinesia

Neuroleptics were the first modern class of pharmacotherapeutic agents available for the treatmentof schizophrenia. Although they were effective in reducing florid psychotic symptoms, up to 90% oftreated individuals subsequently developed extrapyramidal symptoms (EPS) (akathisia, dystonia, orparkinsonism), and about 20% developed tardive dyskinesia (TD). When clozapine became commerciallyavailable for treatment-resistant and treatment-intolerant (i.e., prone to EPS and TD) schizophrenicindividuals, it became apparent that an antipsychotic need not induce motor side effects to beefficacious in reducing the symptomatology of schizophrenia. Sociodemographic, behavioral, andclinical predictors of TD are useful in identifying a subset of schizophrenic individuals who wouldbenefit from treatment with clozapine, the prototype atypical antipsychotic whose efficacy and motorside effect profile are superior to those of chlorpromazine. This favorable motor side effect profile ofclozapine contributes to improved patient outcomes by reducing noncompliance, substance abuse,and suicide, resulting in improved quality of life and savings on health care costs.