Incontinence and clozapine

Urinary incontinence is an embarrassing and distressing side effect of the antipsychotic drug clozapine and a Korean study followed 87 people who had taken the drug for 2 years to see if the symptoms persisted. At the start of the study 10.9% of the sample reported incontinence with 41.6% having clinically-significant lower-urinary-tract symptoms. After two years the participants' score on the International Prostate Symptom Score scale had increased (i.e. they had got worse) and so had the number of participants with lower-urinary-tract symptoms (43.7%) although the change was not statistically significant. The prevalence of lower-urinary-tract symptoms was higher in the people who had taken clozapine than in the general population of the same age.

Jeong, Seong Hoon ... [et al] - A 2-year prospective follow-up study of lower-urinary-tract symptoms in patients treated with clozapine Journal of Clinical Psychopharmacology December 2008, 28(6), 618-624

Dosage and treatment-resistant schizophrenia

Around 30% of people with schizophrenia have a treatment-resistant form of the condition which does not respond well to antipsychotic drugs. Clozapine is the standard treatment for such patients although it can have serious side effects such as agranulocytosis (a low white blood cell count) and weight gain. However, a study of 40 schizophrenia patients in the U.S. has found that it may be the higher doses at which clozapine is prescribed rather than the drug itself which makes it effective in treating non-responsive schizophrenia. The study found that another drug, olanzapine, when used at a higher dose than usual was just as effective as clozapine. The treatment-resistant schizophrenia responded more slowly to higher doses of olanzapine and clozapine than other forms of the condition taking six months for an improvement to be felt rather than six weeks which was the case for the more treatment-responsive form of the condition.

You can find out more about this research at

http://psychcentral.com/news/2008/02/19/med-dosage-vital-for-schizophrenia/1934.html

Clozapine : service users more positive than clinicians

The antipsychotic drug clozapine has been recognised to be particularly effective in the treatment of treatment-resistant schizophrenia and schizoaffective disorder. There are monitoring programmes and protocols to manage clozapine's potentially life-threatening side effects but the constant monitoring involved can be very intrusive. There are also other minor side-effects of the drug which can be unpleasant, inconvenient, and, at times, extremely embarassing. An Australian study of 27 people taking clozapine looked at their experience and perceptions of the drug and compared it to the perceptions of their treating clinicians. Consumers reported drooling mouth as the most prevalent and severe side effect whereas clinicians saw difficulty staying awake as the most prevalent side effect and sleeping too much as the most severe one. Most clinicians overestimated the prevalence and severity of clozapine side effects. Most clinicians and consumers agreed that clozapine lifted mood. Only 19% of consumers were unhappy about blood tests whereas 52% of clinicians estimated that consumers were unhappy about them. The study suggests that despite significant side effects and regular blood tests most stable consumers taking clozapine were happier and more satisfied with their treatment than many of the clinicians believed they were.

Hodge, Kay and Jespersen, Sean - Side-effects and treatment with clozapine: a comparison between the views of consumers and their clinicians. International Journal of Mental Health Nursing January 2008, 17(1), 2-8