Clozapine as treatment of first choice in first psychotic episodes. What do we know?

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Title:	Clozapine as treatment of first choice in first psychotic episodes. What do we know?
Alternate Title:	Clozapina como tratamiento de primera elección en primeros episodios psicóticos ¿qué sabemos?
Authors:	Vera, Ignacio¹ ignacioveralopez@yahoo.es, Rezende, Livia¹, Molina, Vicente², Sanz-Fuentenebro, Javier³
Source:	Actas Espanolas de Psiquiatria. sep/oct2012, Vol. 40 Issue 5, p281-289. 9p.
Subjects:	SCHIZOPHRENIA treatment, CLOZAPINE, PSYCHIATRIC treatment, PSYCHOSES, DRUG efficacy, SIDE effects of antipsychotic drugs, MORTALITY, THERAPEUTICS
Abstract (English):	Schizophrenia is currently conceptualized as a neurodevelopmental disorder with progressive clinical, neurophysiological and neurostructural deterioration mostly occurring at early stages of the disease. During the last years, several early intervention programs have tried to modify the natural history of the disease. The choice of antipsychotic treatment adapted to the specific needs of the patient would make it possible to optimize the results of the intervention programs in first psychotic episodes. Clozapine has become a keystone in the treatment of psychosis, with multiple contributions to the treatment of schizophrenia. Clozapine has been proven superior to other antipsychotics in efficacy and effectiveness with comparable cost-effectiveness to that accepted for many medical interventions. On the other hand, recent studies indicate that the incidence and mortality of clozapine-induced agranulocytosis could be lower than previously estimated and that all-cause mortality due to clozapine is less than that associated to other antipsychotic drugs. However, in spite of clinical guideline recommendations, clozapine is used less and later than recommended. There is a lack of studies comparing clozapine with other antipsychotics in first episode psychosis patients. The aim of our paper is to review the current medical evidence about the use of clozapine as a first-line treatment for naive first episode psychosis patients. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	La esquizofrenia se conceptualiza, en la actualidad, como una enfermedad del neurodesarrollo con un deterioro clínico, neurofisiológico y neuroestructural, especialmente notorio en las etapas iniciales de la enfermedad. En los últimos años, los programas de intervención precoz buscan tratar de modificar el curso natural de la enfermedad. La elección de un tratamiento antipsicótico ajustado a las necesidades específicas del paciente permitiría optimizar los resultados de los programas de intervención en primeros episodios psicóticos. La clozapina ha sido un fármaco clave en la historia del tratamiento de la psicosis y sus aportaciones en el tratamiento de la esquizofrenia han sido múltiples. Ha demostrado su superioridad sobre otros antipsicóticos en términos de eficacia y efectividad con un costoefectividad comparable al aceptado para numerosas intervenciones médicas. Por otro lado, estudios recientes indican que la incidencia y mortalidad asociadas a la agranulocitosis por clozapina serían inferiores a las estimadas en estudios previos y la mortalidad global por clozapina inferior a la asociada a otros antipsicóticos. A pesar de las recomendaciones de las guías clínicas, la clozapina se emplea con mucha menor frecuencia y más tardíamente de lo recomendado y los ensayos clínicos comparando la eficacia y efectividad de la clozapina frente a otros antipsicóticos en primeros episodios psicóticos son prácticamente inexistentes. En el presente artículo de revisión selectiva pretendemos revisar la evidencia clínica existente acerca del empleo de clozapina en primeros episodios psicóticos que nunca han recibido tratamiento farmacológico. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Schizophrenia is currently conceptualized as a neurodevelopmental disorder with progressive clinical, neurophysiological and neurostructural deterioration mostly occurring at early stages of the disease. During the last years, several early intervention programs have tried to modify the natural history of the disease. The choice of antipsychotic treatment adapted to the specific needs of the patient would make it possible to optimize the results of the intervention programs in first psychotic episodes. Clozapine has become a keystone in the treatment of psychosis, with multiple contributions to the treatment of schizophrenia. Clozapine has been proven superior to other antipsychotics in efficacy and effectiveness with comparable cost-effectiveness to that accepted for many medical interventions. On the other hand, recent studies indicate that the incidence and mortality of clozapine-induced agranulocytosis could be lower than previously estimated and that all-cause mortality due to clozapine is less than that associated to other antipsychotic drugs. However, in spite of clinical guideline recommendations, clozapine is used less and later than recommended. There is a lack of studies comparing clozapine with other antipsychotics in first episode psychosis patients. The aim of our paper is to review the current medical evidence about the use of clozapine as a first-line treatment for naive first episode psychosis patients. [ABSTRACT FROM AUTHOR]
ISSN:	11399287