Clozapine is the first antipsychotic drug with proven superiority over conventional antipsychotics in the management of treatment-resistant patients. We describe a case of tratment-resistant schizoaffective disorder in a young woman who improved rapidly on clozapine. The patient was started on a low dose of clozapine while fluphenazine was decreased. She improved significantly during the first several days of treatment. This improvement took place well before the expected effect of clozapine. Possible explanations for this unusual response include: 1) the placebo effect; 2) fluphenazine dose-response curve; 3) acute clozapine neurochemical mechanisms; 4) inaccurate original diagnosis. Better understanding of the mechanisms of action of antipsychotic drugs may considerably improve patient care.
Sher, Leo M.D. and Mendelowitz, Alan M.D.
"Case Report of Dramatic Resolution of Psychotic Symptoms During Cross-Over to Clozapine,"
Jefferson Journal of Psychiatry:
2, Article 8.
Available at: http://jdc.jefferson.edu/jeffjpsychiatry/vol14/iss2/8