The ever-growing case for clozapine in the treatment of schizophrenia: an obligation for psychiatrists and psychiatry

Abstract

Purpose of reviewClozapine remains the gold standard for treatment-resistant schizophrenia (TRS). Although the evidence base for its wide-ranging, unique efficacy continues to expand, clozapine remains alarmingly underutilized in industrialized countries. Analyzing the causes and consequences of this problem is crucial for substantially improving the quality of care for TRS patients.Recent findingsClozapine is the most effective antipsychotic for reducing all-cause mortality in TRS. In most cases, treatment resistance emerges during the first psychotic episode. Delaying clozapine treatment has a negative impact on long-term outcome. Patients’ experience with clozapine treatment is largely positive despite a comparatively high rate of side effects. Patients prefer clozapine, while psychiatrists regard it as a burden due to concerns regarding safety and side effect management. Shared decision-making (SDM), which increases the likelihood of a clozapine recommendation, is not routinely used, possibly due to stigmatization of TRS patients.SummaryThe mortality-reducing effects of clozapine alone warrant its regular use. Therefore, psychiatrists must not exclude patients from the decision regarding a clozapine trial by not even offering it. Rather, they have a clear obligation to align their actions more closely with the existing evidence and patients’ needs and to facilitate the timely initiation of clozapine.

When, Why and How to Re-challenge Clozapine following Myocarditis

“…Our case underscores the central role of slow dose titration regimens below current official recommendations and the impact of concomitant medication as well as the benefits of adequate monitoring for the safe use of clozapine. Finally, establishing CMR as a standard clinical tool for the detection of CIM and for monitoring its sequelae might facilitate the swiftly re-initiation of clozapine, which remains an indispensable treatment for many patients [49,50]. LGE = late gadolinium enhancement…”

“…Its relatively high side-effect load makes the use of clozapine comparatively demanding for prescribers and require a comprehensive detection and management of side-effects [49]. Nevertheless, due to its broad and unrivalled efficacy, increasing the number of eligible patients who receive clozapine is imperative for both medical and ethical reasons [50]. Efforts to address the considerable underutilization of clozapine across industrialized countries [51], should also extend to patients, who have previously been discontinued from clozapine because of serious side effects including CIM.…”

Enhancing Predictive Power: Integrating a Linear Support Vector Classifier with Logistic Regression for Patient Outcome Prognosis in Virtual Reality Therapy for Treatment-Resistant Schizophrenia

“…However, about 30% of people with schizophrenia will not respond adequately to these medications and will be referred to as treatment-resistant schizophrenia (TRS) patients [24]. For those patients, most clinical guidelines support that a failure to respond to two antipsychotics warrants a trial of clozapine: a second-generation antipsychotic [25]. This approach is the current standard treatment for patients suffering from TRS.…”