Treatment refractory patients also showed early-good and
delayed-partial trajectories, with a smaller proportion but
still a majority (57%) being assigned to the early-good
trajectory group. This supports the goal of optimizing
treatment response, and specifically using clozapine for
this purpose. While the overall outcome for the refractory
early-good trajectory group was not as good as in the mixed
group, the reduction of mean BPRS item score by 49%
likely represents a clinically meaningful improvement.11,32
As well, long-term outcomes for seriously ill patients
prescribed clozapine may be encouraging.33 Interestingly,
the percentage of clozapine-treated (previously) refractory
patients in the early-good trajectory group (71%) exceeds
the percentage of chlorpromazine patients in the earlygood
trajectory group (44%) by almost exactly the same
difference (27%) as described for clozapine, compared
with chlorpromazine responders (30%, compared with 4%,
respectively; 26% difference) in the initial report of this
study.12 A schizophrenia-clozapine responsive type appears
to be a real entity, perhaps in as many as 15% to 20% of
patients overall