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Cited by 59Schizophrenia research and treatmentTreatment of Major DepressionNeurotransmitter Receptor Influence on Behavior

Clozapine Monotherapy as a Treatment for Antipsychotic-Induced Tardive Dyskinesia: A Meta-Analysis

Open access
Mentzel, Thierry Q., van der Snoek, René, Lieverse, Ritsaert, Oorschot, Margreet, Viechtbauer, Wolfgang, Bloemen, Oswald, van Harten, Peter N.·2018·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.17r11852
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Abstract

OBJECTIVE: Tardive dyskinesia (TD) is an antipsychotic-induced movement disorder that typically occurs after long-term exposure to antipsychotic drugs. There is evidence that switching to clozapine reduces TD. This meta-analysis reviews the effect of switching to clozapine on the severity of TD. DATA SOURCES: The PubMed, PsycINFO, and Embase databases were searched for clozapine, tardive dyskinesia, and related keywords. The search was restricted to articles written in English and Dutch, and it was last updated on October 13, 2015. STUDY SELECTION: Sixteen studies were included in the meta-analysis. Inclusion criteria were a diagnosis of schizophrenia or a related disorder, a switch to clozapine monotherapy, and reports of scores on a TD rating scale before and after the switch to clozapine. DATA EXTRACTION: Two independent investigators extracted the data. Data were converted to standardized mean change scores and analyzed in a random-effects model. RESULTS: A random-effects model showed that the overall effect of switching to clozapine was a significant reduction in TD (npatients = 1,060, d = -0.40, P < .01), especially in the 4 studies that investigated the severity of TD as a primary outcome (npatients = 48, d = -2.56, P = .02). CONCLUSIONS: The overall results show that clozapine treatment can yield a slight reduction in TD. The severity of TD was reduced greatly in patients with moderate to severe TD. In patients with minimal to mild TD, switching to clozapine seldom worsens TD and a trend toward reduction is seen. These results support that a switch to clozapine should be considered for patients with moderate to severe TD and/or patients who experience substantial discomfort due to TD.

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Authors
Mentzel, T. Q., van der Snoek, R., Lieverse, R., Oorschot, M., Viechtbauer, W., Bloemen, O., & van Harten, P. N.
Affiliations
  • Maastricht University (NL)
  • Yulius (NL)
Corresponding author
Mentzel, Thierry Q.
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2018-09-18
Volume
79
Issue
6
ISSN
  • 0160-6689 (ISSN-L)
  • 1555-2101
DOI
10.4088/jcp.17r11852
OpenAlex
W2891946188
Cited by
59
References
18
Citations by year
2026: 1 · 2025: 11 · 2024: 10 · 2023: 3 · 2022: 8 · 2021: 6 · 2020: 9 · 2019: 10 · 2018: 1
FWCI
5.08
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
tardive dyskinesia, clozapine, antipsychotic-induced movement disorders, antipsychotic switching, schizophrenia, antipsychotic adverse effects
MeSH terms
Tardive Dyskinesia, Clozapine, Humans, Schizophrenia, Severity of Illness Index, Antipsychotic Agents, Drug Substitution

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