Effect of Clonazepam in the Chronic Schizophrenics with Treatment-Refractory Hallucinations: A Preliminary Report

Yi, Jung Seo; Jung, Hee Yeon; Yoon, Se Chang; Ahn, Yong Min; Lee, Chang In; Kim, Yong Sik

Abstract

OBJECTIVES
Many chronic schizophrenics are suffered from treatment-refractory hallucinations. As a countermeasure, the combined use of neuroleptics and benzodiazepines has been studied. In this context, the authors tried to evaluate the anti-hallucinatory effect of neuroleptics-clonazepam combination therapy.
METHODS
At first, the authors described 3 cases of chronic schizophrenics who reported alleviation of hallucinations, which are resistant to neuroleptic treatment, after adding clonazepam. And then, prospective open study including 6 female chronic schizophrenic inpatients having neuroleptic-refractory hallucinations was done. In addition to existing psychiatric medication, these patients were treated with clonazepam 1.5 mg for 6weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 6 weeks of treatment. The psychopathology was assessed by the items of hallucinatory behavior and anxiety/tension of PANSS and BPRS. Clinical improvement was defined by fall-off of the hallucinatory behavior below the moderate level. The side effects were assessed by UKU Side Effect Rating Scale.
RESULTS
All patients completed 6 weeks' trial. At the end of 6 weeks, 2 (33.3%) of 6 patients showed decrement of the hallucinatory behavior below the moderate level, when evaluated by PANSS and BPRS. However, the courses of anti-hallucinatory effect were different in these 2 patients. Another one patient showed that the hallucinatory behavior assessed by BPRS fell to the moderate level, but not when assessed by PANSS. The item of anxiety/tension was unchanged in all 6 patients. Except very mild sedation in one patient, there was no side effect.
CONCLUSION
This study suggests that neuroleptics-clonazepam combination therapy is effective against treatment-refractory hallucinations in some schizophrenics and generally safe.