Dual Diagnosis

The evidence obtained is based on an open level, naturalistic, and prospective study, involving one hundred patients, referred for Clozapine therapy. Data was obtained from patients and key relatives after informed consent. After therapy began, patients received a follow-up evaluation on day 90 and again on the last day of treatment duration of one year. Side effects were recorded using a checklist prepared for Clozapine-related side effects.

Base line investigations included blood count, haemogram, liver function, kidney function, ECG. Blood monitoring was done once per week for 3 months and then once every two weeks following. Psychopathology measurement and outcome measurement was done using GCIS, GAF and PANSS. The patients included 62 men and 38 women of low to middle socio-economical class, ranging in age from 28 to 56 years, averaging 34 years of age. 38% were married, 43% were single, and 19% were separated.

The duration of illness prior to the study ranged from 5 to 21 years, averaging 7 years. Patients’ duration of illness before first psychiatric contact ranged between 5 months and 46 months, averaging 20 months. Prior to the study, 55% of the patients had a history of hospitalization, averaging 2 prior hospitalizations and the mean duration of hospitalization was 2 months. A history of violence was recorded in 46% of patients and 72% had a history of behavioral disruption.

28% of the patients had attempted suicide. Some were unable to function in society- 66% were socially disabled and 74% had little or no occupational functionality. One fourth of the patients had a positive family history of some psychological disorder. Schizophrenia was diagnosed in 16% of those relatives: 5% in siblings, 8% in parents, and 3% among offspring. Other psychological disorders, including alcoholism, depression, and suicide attempts were confirmed in first-degree relatives among 9% of the patients.

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