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Am J Psychiatry 1996; 153:1628-1630
Copyright © 1996 by American Psychiatric Association
D-cycloserine added to clozapine for patients with schizophrenia
DC Goff, G Tsai, DS Manoach, J Flood, DG Darby and JT Coyle
Psychotic Disorders Program, Massachusetts General Hospital, Boston, USA. goff@psych.mgh.harvard.edu
OBJECTIVE: The effects of D-cycloserine added to clozapine were assessed
and compared with previous results for D-cycloserine plus conventional
neuroleptics. METHOD: Ten schizophrenic outpatients receiving clozapine
entered consecutive 2-week trials of placebo and D- cycloserine at 5, 15,
50, and 250 mg/day. Clinical evaluations were videotaped and scored by a
rater blind to the sequence of assessments. RESULTS: There was a
significant dose effect of D-cycloserine on scores on the Scale for the
Assessment of Negative Symptoms (SANS); the 50-mg dose produced a mean 21%
increase in SANS score. The patients had significantly higher baseline
serum glutamate concentrations than the patients receiving typical
neuroleptics in the previous trial. Baseline glutamate level and change in
glycine level significantly correlated with response of negative symptoms
to 50-mg D-cycloserine. CONCLUSIONS: The improvement of negative symptoms
with D-cycloserine previously observed in patients receiving typical
neuroleptics did not occur in patients treated with clozapine.
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