Clozapine and Schizophrenia: Impact on Reducing Psychotic Symptoms and Preventing Suicides

• DOI: https://doi.org/10.22533/at.ed.1594822402091

• Palavras-chave: Clozapine; Schizophrenia; Suicide prevention; Atypical antipsychotics; Hematological monitoring.

• Keywords: Clozapine; Schizophrenia; Suicide prevention; Atypical antipsychotics; Hematological monitoring.

• Abstract: INTRODUCTION The treatment of schizophrenia has significantly evolved over the decades, with clozapine emerging as an effective antipsychotic for refractory patients. The prevalence of suicide among patients with schizophrenia is high, and clozapine is the only antipsychotic proven to significantly reduce this rate. The efficacy of clozapine, along with the challenges associated with its use, such as agranulocytosis and the need for rigorous monitoring, are discussed. OBJECTIVES To evaluate the efficacy of clozapine in reducing psychotic symptoms and preventing suicides in patients with schizophrenia. METHODS This is a narrative review. PubMed, SciELO, and Medline databases were used with the following descriptors: "Clozapine" AND "Schizophrenia" OR "Antisuicidal effect" OR "Antipsychotics" OR "Hematological monitoring" in recent years. RESULTS AND DISCUSSION Recent studies confirm the superiority of clozapine in reducing psychotic symptoms and preventing suicides compared to other atypical antipsychotics. Clozapine modulates neurotransmitters and has neuroprotective effects contributing to its efficacy. However, treatment with clozapine is associated with significant side effects, including agranulocytosis and metabolic complications that require constant monitoring. The quality of life of patients on clozapine treatment is generally superior despite adherence challenges and the costs associated with monitoring. CONCLUSION Clozapine represents a crucial advance in the treatment of schizophrenia, particularly for refractory patients and those at high risk of suicide. Although it comes with significant challenges, such as the need for rigorous monitoring and the management of adverse effects, its benefits in reducing hospitalizations, improving social functionality, and preventing suicides justify its use. Multidisciplinary approaches and continuous research are essential to maximize the efficacy and safety of clozapine.