Human figure drawings as a method of quantitative monitoring progress of clozapine treatment in severely confused patients
Zack Zdenek Cernovsky, Lamidi Kola Oyewumi
Background: The progress in clozapine treatment is notoriously slow and often unnoticeable to busy clinicians who may then erroneously discontinue it after within two months, thus depriving the patient of the possibility to function independently outside of the hospital, in the community. We present a psychological method for quantitative monitoring of the progress (cognitive improvement) in initial stages of clozapine treatment in those patients with intractable schizophrenia who are too confused to be evaluated by other methods. Method: The patient is instructed to draw a person at different points of time before clozapine and then repeatedly over the first weeks and months of clozapine therapy. The drawings are scored on a scale from 0 (no recognizable human figure, face, or another body part is discerned in the scribble) to 6 (human face or entire human figure is drawn without noticeable distortions and outside of unrelated scribble). Results: The drawings are presented, those made by an initially very confused patient with intractable schizophrenia and history of numerous hospital admissions and unsuccessful attempts at treatment by novel antipsychotics other than clozapine. The scores on his drawings improved very slowly but steadily from 0 to 5 over the first 5 months of treatment, i.e., from irrecognizable scribble to recognizable persons. The score increase had its equivalent in improvement of adaptive behavior and in symptoms manifested by the patient. Discussion and Conclusions: This method is designed for very confused patients with intractable psychosis whose very slow and too subtle treatment progress would risk to remain unnoticed by busy clinicians, especially by those who routinely discontinue clozapine within the first 2 months, erroneously assuming that no progress was achieved.