Symptoms in schizophrenia are defined as positive and negative (Table 19.4). Whilst a classical antipsychotic drug should provide adequate treatment of positive symptoms including hallucinations and delusions in at least 60% of cases, patients are often left with unresolved negative symptoms such as apathy, flattening of affect and alogia. Evidence suggests that clozapine and the newer atypicals have a significant advantage over classical drugs against negative symptoms. Clozapine has a further advantage over all other antipsychotics, whether classical or atypical, in that it may be effective when other antipsychotics prescribed at adequate doses have failed or are not tolerated.
Schizophrenia often runs a chronic relapsing and remitting course. Less than one-quarter of patients who experience a psychotic episode and are diagnosed as having schizophrenia succeed in avoiding further episodes. Nevertheless, taking antipsychotics as prophylaxis significantly reduces the likelihood of relapse.
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