The International Journal of Neuropsychopharmacology

Table of Contents - 2001 - Volume 4, Issue 02  


Letter to the Editor

Effectiveness of clozapine and olanzapine: a comparison in severe, psychotically ill patients

Rosaria  Di Lorenzo  PhD a1 c1, Grazia  Tondelli  PhD a1 and Susanna  Genedani  ScD a2
a1 Department of Mental Health, ‘Presidio Psichiatrico di Diagnosi e Cura 1', Policlinico, Via del Pozzo 71, Modena, Italy
a2 Department of Biomedical Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, Via Campi, 287, I41100 Modena, Italy

Abstract

New atypical antipsychotics have opened a new era in the treatment of schizophrenia owing to their effectiveness both on positive, but especially negative, symptoms, without extrapyramidal side-effects (Tandon et al., 1999). The archetypal atypical antipsychotic is clozapine, whose main side-effect is agranulocytosis. Recently, other new atypical antipsychotics have been developed, such as olanzapine (Stephenson and Pilowsky, 1999), which do not produce any adverse haematological effects (Beasley et al., 1997). Clozapine and olanzapine share lower D2 and D3 receptor affinity in the basal ganglia and nigrostriatal system, and higher affinity to muscarinic (M) and histaminergic (H) receptors than haloperidol. Moreover, clozapine has higher affinity to adrenergic (α1 and α2) receptors, while olanzapine has higher affinity to D2, D3, D4 and serotonergic (5-HT-2A) receptors (ratio 5-HT-2A/D2 > 2) (Coward, 1992). The pharmacological profile can explain the efficacy of these drugs not only on the positive, but also especially on the negative symptoms, representing the originality of new antipsychotic treatment. The improvement of primary negative symptoms (Crow, 1980) and the absence of secondary symptoms (produced by extrapyramidal side-effects) result in an increased compliance (Marder, 1998) and improvement of cognitive functions (insight capacity, self-awareness, judgement) (Meyer-Lindenberg et al., 1997).

The aim of our study was to evaluate the effectiveness of clozapine and olanzapine in the treatment of schizophrenic patients in our psychiatric department. This is constituted by hospital wards connected to community services (outpatient care, semi-residential and residential centres for rehabilitative social programmes).

(Received July 26 2000)
(Reviewed November 20 2000)
(Revised January 24 2001)
(Accepted February 7 2001)


Correspondence:
c1 Address for correspondence: Dr R. Di Lorenzo, Department of Mental Health, Presidio Psichiatrico di Diagnosi e Cura 1, Policlinico Via del Pozzo 71, I41100 Modena, Italy. Tel.: 0039-59-422232-951 Fax: 0039-59-422589 or 0039-59-2055376 E-mail: genedani@unimo.it

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