Common Side Effects and Metabolic Syndrome due to Clozapine: Relationship with the Clinical Variables and Disability. / Klozapine Bagli Sik Görülen Yan Etkiler ve Metabolik Sendrom: Klinik Degiskenlerle ve Yetiyitimiyle Iliskisi.

OBJECTIVE: Common side effects of clozapine may affect the treatment process negatively. In this study, we aimed to assess the common side effects and the prevalence of metabolic syndrome in schizophrenia patients treated with clozapine, and to study their relationship with clinical variables and disability. METHOD: One hundred and twenty two patients who met DSM-IV criteria for schizophrenia, and were on clozapine treatment were included in the study. Clinical status was evaluated through a clinical interview and review of the medical records, and physical measures and laboratory tests were recorded. Patients were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale, World Health Organization (WHO)-Disability Assessment Schedule II, Positive and Negative Syndrome Scale, Global Assessment Scale, Clinical Global Impression Scale. RESULTS: Common side effects of clozapine were hypersalivation, fatigue, sedation and constipation. The relationship between constipation and clozapine dose, and dizziness and norclozapine plasma levels were significant. The prevalence of metabolic syndrome was 50%, and patients with metabolic syndrome had higher means of age and lifetime cigarette consumption. Disability was positively correlated with the severity of psychopathology and the number of side effects, and negatively correlated with the age at onset of illness. Severity of the psychopathology and the number of side effects predicted the severity of the disability. CONCLUSION: Clozapine was associated with various side effects and half of the patients had metabolic syndrome. Assessment of common side effects due to clozapine is important for reducing disability.

[Augmentation of Clozapine Due to Inadequate Treatment Response in Schizophrenia: Comparison of Patients with Augmented and Non-augmented Treatments]. / Sizofrenide Klozapine Yetersiz Yanit Nedeniyle Tedavi Güçlendirme: Güçlendirme Yapilan ve Yapilmayan Hastalarin Karsilastirilmasi.

OBJECTIVE: Clozapine is considered to be a gold standard antipsychotic in treatment resistant schizophrenia. This study aims to investigate clozapine augmentation METHODS utilized in schizophrenia and compare the sociodemographic characteristics, clinical features and remission states of patients whose treatments are augmented and not. METHOD: This study included 122 outpatients diagnosed with DSMIV schizophrenia. Patients were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, Positive and Negative Syndrome Scale, Clinical Global Impression Scale, Global Assessment of Functioning, Calgary Depression Scale for Schizophrenia, Panic Agoraphobia Scale, Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Schedule II. The remission state of the patients was assessed utilizing the Remission in Schizophrenia Working Group criteria for schizophrenia. RESULTS: Combined antipsychotic drug use was the most prevalent method utilized for clozapine augmentation. Patients on augmentation treatment were on higher daily clozapine doses and their remission rates were lower. In addition, the severity of psychopathology related with schizophrenia and comorbid symptoms, the level of functioning and disability were worse in this particular patient group. History of antipsychotic combination use prior to clozapine was found to predict the future use of clozapine augmentation. CONCLUSION: Adding a second antipsychotic seems to be the most common method of augmenting clozapine treatment in schizophrenia. The group of patients whose clozapine treatment is augmented appears to represent a "more difficult to treat" patient group before clozapine is initiated.