NEENA DESAI et al. TABLE 2 PERCENTAGE IMPROVEMENT ON BPRS TOTAL SCORES FROM BASELINE Percentage Improvement After 3 months (N=28) 0-25 26-50 51-75 76 & above 3(10.71%) 14(50.00%) 10(35.72%) 1( 3.57%) (50%) had shown improvement in the range 26-50%, with 10(35.72%) patients having improvement in the range of 51-75% whereas only 3(10.71%) patients did not show improvement beyond 25% from the baseline. TABLE 3 SIDE EFFECT PROFILE OF CLOZAPINE OVER 3 MONTHS Symptoms Total No. of Patients (n=28) Sedation Sialorrhoea Dizziness Constipation Hypotension Weight gain Tachycardia G.I. Upset Anticholinergic effects Fainting Spells Myoclonus Seizures Agranulocytosis 26 (92.85%) 26 (92.85%) 16 (57.14%) 14 (50.00%) 11 (42.85%) 11 (42.85%) 5 (17.85%) 4 (14.28%) 2 ( 7.14%) 2 ( 7.14%) — _. — The side effects profile revealed sedation and sialorrhoea to be the most frequently observed side effects in 26(92.85%) patients. Hypotension and weight gain were seen in 11 (42.85%) patients. A significant finding was that none of the patients developed agranulocytosis. The regular monitoring of the blood count towards the end of 3 months, revealed an increase in the count in 7(25%) patients, though it was not above 13,000/cu mm and a decrease in 4(14.28%) patients but not below 4,000/cu mm. The mean dose of clozapine in our study was 241 mg/day. As evident from the table, only 6(21.45%) patients required doses more than 325 mg/day by the end of 3 months. 9(32.13%) patients were receiving clozapine in the range 226-325 mg/day, 8 (28.57%) patients responded TABLE 4 DOSE OF CLOZAPINE Dose Range (mg/day) 25-125 126-225 226 - 325 326 - 425 426 - 525 At 3 Months Total No. of Patients (n=28) 5(17.85%) 8(28.57%) 9(32.13%) 4(14.30%) 2( 7.15%) to clozapine in the range 126-225 mg/day whereas, 5(17.85%) patients were maintained on doses between 25-125 mg/day. DISCUSSION Clozapine has found to result in moderate to marked overall symptomatic improvement in approximately 60-80% of patients with acute or chronic schizophrenia. Marked improvement consistently occurred in symptoms of hallucinations, hostility and thought disorders (Klik,1976; Lapierre,1980). This finding was also seen in our study where many of the positive symptoms of schizophrenia responded earlier when rated on the BPRS. As we had not used the Positive and Negative Syndrome Scale (Kay et al.,1988), we could not comment on those patients having associated negative symptoms or their improvement in comparison to the positive symptoms in our study. Though clozapine is more propagated for the negative symptoms of schizophrenia, it definitely improves the positive symptoms much earlier in treatment resistant schizophrenics (Kane, 1988). Meltzer et al.(1989) reported that affective flattening and anhedonia did not respond to clozapine. Studies by Conley et al. (1994) and Brier et al.(1994) also suggest that the drug helps only in ameliorating the secondary negative symptoms rather than the primary negative symptoms. Kane (1993) also reported a pronounced anxiolytic effect within 1-2 weeks of clozapine therapy, before the onset of its antipsychotic action. A 50-75% decrease in the total BPRS score with clozapine was seen in 35.72% of our patients by the end of 3 months. However, previous studies revealed only a 20%