Abstract
Most reports of clozapine in treatment-refractory patients have dealt with outpatient and/or relatively less chronic samples. This report focuses on clinical outcome in an institutionalized sample, notable for chronicity, poor functioning, and representing the extreme segment of the treatment-refractory population. We analyzed the data for 50 persistently hospitalized patients referred for clozapine treatment in open trials. Dimensions of outcome assessed at baseline and periodically thereafter included psychopathology, cognitive performance, extrapyramidal side effects (EPS), and patient satisfaction. Certain features of clozapine response in institutionalized patients have been underemphasized (e.g., reduced use of restraint and seclusion, greater social interaction, reduced cost for care). Ninety-four percent of this sample showed some form of improvement with clozapine. Improvement ranged from modest (e.g., less EPS) to remarkable (e.g., discharge). An adequate clozapine trial may require more than 6 months.