We commend Kumra and associates1 for their contribution to the scant literature on the treatment of childhood schizophrenia with atypical antipsychotics. Their controlled study found that clozapine (dosage range, 25-525 mg/d) is more effective than haloperidol in treatment-resistant childhood-onset schizophrenia. However, controlled studies may not detect unusual phenomena, such as individuals who require a very high clozapine dosage for adequate therapeutic response. We therefore report a case of childhood-onset schizophrenia in a youth who needed a clozapine dosage of 975 mg/d for optimal response. This case is also presented for heuristic purposes: Is it possible that in some cases inadequate response to clozapine may be due to inadequate dosage? We would be interested in the comments of Kumra et al.
Bhatara VS, Gupta S, Flugsrud-Breckenridge M. Childhood-Onset Schizophrenia. Arch Gen Psychiatry. 1998;55(1):90–91. doi: