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S. Craig Risch, MD
Department of Psychiatry Medical University of South Carolina 171 Ashley Ave Charleston, SC 29425-0742

Richard R. J. Lewine, PhD
Atlanta, Ga

Arch Gen Psychiatry. 1993;50(8):670.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Pickar et al¹ reported the superior efficacy of clozapine over fluphenazine and placebo in eight (38%) of 21 neuroleptic treatment—resistant or —intolerant schizophrenic patients. They noted that this was consistent with the 30% clozapine superiority in the neuroleptic nonresponders reported by Kane et al.²

The superior clozapine response of the patients of Pickar et al was associated with a relatively low ratio of concentrations of cerebrospinal fluid (CSF) homovanillic acid (HVA) to 5-hydroxyindoleacetic acid (5-HIAA) (CSF HVA-5-HIAA ratio) compared with the CSF HVA-5H1AA ratio in patients having an equivalent or superior response to fluphenazine. They found that a low CSF HVA—5-HIAA ratio at any of three time points—(1) placebo washout, (2) during fluphenazine therapy, and/or (3) during clozapine therapy—was associated with superior clozapine efficacy.

We also have been prospectively studying the same problem. Ten patients meeting Research Diagnostic Criteria for schizophrenia received lumbar punctures in a medication-free . . . [Full Text PDF of this Article]

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