Clozapine-resistant schizophrenia: A positive approach

Williams, Lisa E.; Newton, Graham; Roberts, Kathryn; Finlayson, S.; Brabbins, Clare

doi:10.1192/bjp.181.3.184

Cited by 39 publications

(31 citation statements)

References 32 publications

(29 reference statements)

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“…The clinical trajectory observed was consistent with a diagnosis of resistant schizophrenia according to Andreason et al's remission criteria [15]. Moreover, this condition could also have been related to clozapine-resistant schizophrenia [16]. Because his clinical trajectory was observed in a psychiatric hospital setting, the possibility that external factors influenced his psychopathology and clinical course could be excluded.…”

Section: Case Presentationsupporting

confidence: 57%

A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in the Left Sylvian Fissure

Jang¹,

Choi²,

Park³

2014

J Psychiatry

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Previous studies have reported the comorbidity of arachnoid cysts with psychosis; the symptoms include cognitive impairments, delusional thoughts, and hallucinations. However, the incidence of arachnoid cysts with the sudden onset of severe schizophrenia is rare. This paper describes the case of a 39-year-old Korean man with schizophrenia, who presented with a large arachnoid cyst in the left Sylvian fissure and clozapine-resistant psychosis.

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Section: Case Presentationsupporting

confidence: 57%

A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in the Left Sylvian Fissure

Jang¹,

Choi²,

Park³

2014

J Psychiatry

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“…The early use of clozapine is highly desirable, but may not be possible for all patients. Where clozapine fails, a wide range of therapeutic approaches is needed (Williams et al, 2002). If all evidence-based treatments have been explored without a satisfactory clinical response, it may be reasonable to carry out a time-limited therapeutic trial, preferably using rating scales, of an antipsychotic combination.…”

Section: Discussionmentioning

confidence: 99%

Combined antipsychotics for ‘difficult-to-manage’ and forensic patients with schizophrenia: reasons for prescribing and perceived benefits

Haw

Stubbs

2003

Psychiatr. bull.

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Aims and Method We aimed to examine reasons for initiating and continuing the prescription of combined antipsychotics. A structured interview was carried out with the responsible medical officers for 40 ‘difficult-to-manage’ tertiary referral patients with schizophrenia who were regularly treated with two or more antipsychotics. Results Lack of efficacy of monotherapy was the main reason for initiating and continuing combined antipsychotics. Other reasons for continuing combined antipsychotics included not wishing to change medication as the patient was reasonably well, and safety considerations. Perceived benefits of combined antipsychotics included fewer positive symptoms and less disturbed behaviour. Clinical Implications ‘Difficult-to-manage’ and forensic treatment-resistant patients with schizophrenia pose a particular therapeutic challenge. Use of combined antipsychotics, although not evidence-based, is perceived by some psychiatrists as beneficial when other options have failed.

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“…2002.Bu hastalar klozapin tedavisine dirençli veya yüksek dirençli şizofreni hastaları olarak adlandırılır (Buckley ve ark. 2001, Williams ve ark. 2002.…”

Section: Introductionunclassified

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

Vayısoğlu¹,

Yağcıoğlu²

2014

Turkish Journal of Psychiatry

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ÖZETKlozapin tedavisi kullanan şizofreni hastalarının önemli bir oranı tedaviye kısmi yanıt vermektedir. Bu grup hastalarda klozapin tedavisine değişik psikotropların eklendiği güçlendirme yöntemleri ile ilgili bulgular çelişkilidir. Bu derlemede klozapin tedavisine dirençli şizofre-ni hastalarında güçlendirme ajanlarının etkinliği ve güvenliği ile ilgili yazın verileri gözden geçirilmiştir. Klozapini tedaviye dirençli şizofreni hastalarında güçlendirmek için kullanılan ek tedaviler antipsikotikler, antidepresanlar, duygudurum düzenleyicileri, diğer farmakolojik ajanlar (örneğin omega 3 yağ asitleri ve glutamaterjik tedaviler) ve elektrokonvulzif tedavi (EKT) olarak gruplanmıştır. Klozapinin tedaviye dirençli şizofreni hastalarında güçlendirilmesi ile ilgili en çok kontrollü çalışma-nın lamotrijin ve risperidon ile yapılmış olduğu görülmektedir. Ancak, meta analizler iki ajanın da klozapine eklenmesinin yararını desteklememektedir. Klozapinin amisülprid, aripiprazol, mirtazapin, omega 3 yağ asitleri ve EKT ile güçlendirilmesinin olumlu sonuç verdiğini destekleyen çalışmalar olsa da, delil/kanıt yeterli değildir ve ek araştırma-lara gereksinim vardır. Güncel çalışmalarda başlıca kısıtlılık, örneklem küçüklüğü, klozapine direnç tanımının sabit olmaması ve tanımlanmış sonlanım ölçütleri ile çalışma desenlerinin farklılık göstermesidir. Sonuç olarak, klozapin tedavisine dirençli şizofreni hastalarında tedavinin güç-lendirilmesi yöntemlerinin başarısı ile ilgili henüz yeterli kanıt yoktur.Anahtar Sözcükler: Şizofreni, klozapin, tedaviye direnç, güçlendirme tedavisi SUMMARY Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine TreatmentA significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and th...

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Clozapine-resistant schizophrenia: A positive approach

Cited by 39 publications

References 32 publications

A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in the Left Sylvian Fissure

A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in the Left Sylvian Fissure

Combined antipsychotics for ‘difficult-to-manage’ and forensic patients with schizophrenia: reasons for prescribing and perceived benefits

Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine Treatment

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