CLOZAPINE USE IN SCHIZOPHRENIA

Clozapine use in Schizophrenia

ABSTRACT

Physical illness (such as Schizophrenia) is a severe, chronic mental disorder characterized by various behavioral, emotional, and cognitive disturbances. Although the phenomenology of the disorder is highly heterogeneous, common characteristics of the illness can generally be classified into four domains: positive symptoms, negative symptoms, cognitive impairment, and social dysfunction. Positive symptoms include hallucinations, delusions, and disorganization of thinking, speech, and behavior that Physical illness (such as Schizophrenia) patients experience. Negative symptoms consist of deficiencies compared with nonpatients, such as a reduced range of emotional experience and expression, social withdrawal, and diminution in goal-directed behavior. In addition to positive and negative symptoms, Physical illness (such as Schizophrenia) is associated with diminished life satisfaction, poor social and occupational functioning, neurocognitive impairments, and profound deficits in social competence. Cognitive impairment is now recognized as a key characteristic of Physical illness (such as Schizophrenia) that has a significant (negative) impact on functioning. Finally, social dysfunction is a defining feature of Physical illness (such as Schizophrenia) that is stable over time and predictive of the course and outcome of the illness. Cognitive and social deficits are relatively independent of positive and negative symptoms and are not responsive to medication.

Clozapine use has been notably lower in African American patients than in Caucasians. It has been suggested that lower normal ranges for white blood cell (WBC) counts in African Americans, known as benign ethnic neutropenia, may account partially for the disparity.

ACKNOWLEDGEMENT

I would like to take this opportunity to thank my teachers and all the faculty members who have supported me with vigilance through out this project. I would also like to thank my subject teacher for showing confidence in me to carry out this very important project.

Last but not the least, I would like to thank my parents who have remained by my side through thick and thin and have given me all the required moral support during the couse of this project.



Table of Contents

ABSTRACT2

ACKNOWLEDGEMENT3

Chapter 15

INTRODUCTION5

RATIONALE5

BACKGROUND5

REVIEW TOPIC7

AIM7

PARAMETER7

CHAPTER 2: LITERATURE REVIEW10

What is Schizophrenia?10

Causes13

Brief history and mode of action of clozapine20

Studies on efficacy of clozapine22

Other Drugs26

Chapter 328

RECOMMENDATIONS AND CONCLUSIONS28

Social Skills Training (SST)34

Description of the Strategy34

Research Basis35

Relevant Target Populations and Exceptions36

Complications37

Cognitive-Behavioral Therapy (CBT)38

Description of the Strategy38

Research Basis39

Relevant Target Populations and Exceptions40

Complications40

Cognitive Remediation (CR)41

Description of the Strategy41

Research Basis43

Relevant Target Populations and Exceptions43

Complications44

Token Economies (TE)44

Description of the Strategy44

Research Basis45

Relevant Target Populations and Exceptions46

Complications46

References47

Chapter 1

INTRODUCTION

RATIONALE

Physical illness (such as Schizophrenia) is perhaps the most complex, severe, and devastating of all mental illnesses. It can manifest in many different ways and forms. People with Physical illness (such as Schizophrenia) can exhibit, for example, a wide combination of psychotic symptoms, behavioral disorganization, and deficits in motivation and affective expression. Schizophrenic individuals may also show a variety of cognitive impairments. All of these symptoms interfere with the person's day-to-day social and occupational functioning. Schizophrenic signs and symptoms typically wax and wane across time and circumstances. Some people with Physical illness (such as Schizophrenia), for example, have periods of time when they think clearly and can function in the community, ...