The British Journal of Psychiatry 131: 172-184 (1977)
© 1977 The Royal College of Psychiatrists
Correlation between plasma chlorpromazine and its metabolites and clinical ratings in patients with acute relapse of schizophrenic and paranoid psychosis
OT Phillipson, JM McKeown, J Baker and AF Healey
Nine patients diagnosed as having acute schizophrenic psychosis were
treated with chlorpromazine. Their clinical response to drug treatment was
measured by the use of a clinical rating scale developed from the Present
State Examination, and a nurses rating scale. Plasma levels of
chlorpromazine (CPZ), 7-hydroxychlorpromazine (7OHCPZ),
monodesmethylchlorpromazine (NOR1CPZ) and chlorpromazine sulphoxide
(SOCPZ), were monitored during the period of hospital treatment.
Correlations were made between the increase in plasma levels of drug or
metabolites and improvement in the different PSE scores. These showed that
the most significant correlations occurred when symptoms with high
diagnostic significance for schizophrenia (Group 1) and symptoms rating
perceptual disorders (P) were correlated with plasma 7OHCPZ levels in
plasma samples taken before the first morning dose of CPZ. The ration of
7OHCPZ to CPZ in these samples increased significantly as clinical ratings
improved, this correlation being most highly significant against the Group
1 and P scores. The ratio of 7OHPCZ to SOCPZ increased significantly only
in the case of Group 1 and P scores. This indicates a preferential shift of
CPZ metabolism towards the formation of the active 7OHCPZ during the period
of clinical improvement.
