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Clozapine is thefirst antipsychotic drug with proven superiority overconventional antipsychotics in the management oftreatment-resistant patients. vVe describe a case oftreatment-resistant schieoaffectioe disorder in a y oung woman who improved rapidly on clozapine. The patient was started on a low dose ofclozapine whilefluphenaeine was decreased. She improved significantly during thefirst several days oftreatment. This improvement tookplace well before the expected ifJect ofclozapine. Possible explanations fo r this unusual response include: J) the placebo ifJect; 2) fluphena zine dose-response curve; 3) acute clorapine neurochemical mechanisms; 4) inaccurate original diagnosis. Better understanding ofthe mechanisms ofaction ofantipsychotic drugs may considerably improvepatient care. C loza pine is th e first a n t ipsycho tic agent wit h proven superior ity over conventional a n t ipsyc ho tics in term s of its efficacy in t reatmentresist ant patie nts (1,2). In patients with poor or partial response to conve ntional neu rolep t ics, cloza pine is th e treatment of choice . We wish to rep ort a nd to discuss a cas e of the rapid a nd subs ta n t ia l improvement of a patient who was started on c1ozapine. PRESENTI IG PROBLEM AND PATIENT DESCRIPTION Ms. C. was a 34 year old whit eJewish fem ale with 13 yea r hist ory of schizoaffective disorder. At th e tim e of admission th e patient reported a ud itory hallu cin a t ions, refer entia l delusions (the patient felt that other peop le were mak ing refe rence to her), a nd th e bel ief that sh e was abl e to read th e minds of peopl e a round her. T he Leo Sh er , M.D. is a fellow at th e National Inst itu te of Mental Health , Bethesda, Maryland. At th e tim e of writ ing this article, he was a resident a t Hill side Hospit al , Psychiatr ic Division of Lon g IslandJ ewish Medi cal Center , th e Lon g Island Campus for th e Albert Einst ein Co llege of Medi cin e, Glen Oaks, New York. Alan Mendelowitz , M.D. is Chief of the Residen cy Train ing and Research Unit at H illside Hospital, Psychi atric Division of Long IslandJewish Medi cal Ce nter , the Long Island Campus for th e Albert Einst ein Coll ege of Medicin e, Glen O ak s, New York , and Assis tant Professor of Psychiat ry, Albert Einstein College of Medi cine, Bronx , New York. The corresponding aut hor: Leo Sher , M.D. , NIMH, Bldg. 10, Rm 3S-23 I, 9000 Rockville Pike, Bethesd a, MD 20892, T el : 30 1-496-2 141, Fax : 30 1-496-5439, E-mail: LSHER@B O XL.NIH.GOV

Case Report of Dramatic Resolution of Psychotic Symptoms During Cross-Over to Clozapine