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The sequential treatment approach to resistant schizophrenia with risperidone and clozapine: results of an open study with follow‐up

In this paper we extend and test with long‐term follow‐up the results of a previous paper on the usefulness of a sequential treatment protocol with risperidone and clozapine in resistant schizophrenia. Twenty‐four patients diagnosed as resistant schizophrenics according to DSM III R and Kane et al.'s (1988) criteria were treated with risperidone for 3 months. Eight patients responded (according to a priori criteria: improvement of basal BPRS, SAPS and SANS total scores over 20 per cent at 3 months observation), while of the remaining 16 patients two dropped out and nine responded to clozapine treatment within the next month. Five patients had partial or no response to clozapine. Follow‐up lasting up to 37 months (mean 22·4 months for risperidone responders and 18·3 months for clozapine responders) showed good stability of response, no significant differences in relapses and re‐hospitalizations between risperidone and clozapine responders and no tardive responses. © 1998 John Wiley & Sons, Ltd.