Abstract

INCHAUSPE AROSTEGUI, José Antonio  and  VALVERDE EIZAGUIRRE, Miguel Ángel. Believing in clozapine: faith and evidence. Rev. Asoc. Esp. Neuropsiq. [online]. 2018, vol.38, n.133, pp.239-262. ISSN 2340-2733.  https://dx.doi.org/10.4321/s0211-57352018000100013.

Many researchers and clinicians think that clozapine is the most effective treatment for patients with schizophrenia. Clozapine is proposed as the treatment of choice for Treatment-Resistant Schizophrenia (TRS) in many clinical guidelines. However, most of the studies do not support this conviction and put into question a real difference among antipsychotics in terms of functional improvement and recovery. In this article, we examine and discuss the evidence of clozapine's higher efficacy; especially, the study of Kane et al. (1988), the trial that found best results for clozapine. According to current research in the field, we conclude that there is no evidence to support clozapine's superiority over other antipsychotics. The study of Kane only shows a small, but not relevant, advantage for clozapine. In addition, its design is biased, somehow inducing the results achieved. Despite this, the beliefs and practices of researchers and clinicians have not changed. We discuss the reasons for this state of things and suggest some significant changes in the clinical practice and in research. These changes are aimed at the development of a collaborative clinical practice that integrates psychotherapies and support in the community, and is oriented towards functionality, recovery, and quality of life.

Keywords : randomized controlled trial (RCT); treatment-resistant schizophrenia (TRS); antipsychotics; clozapine; improvement.

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