The Magic Shotgun: Does It Fit the Clinician and Will It Point at Schizophrenia?

Mortimer, Ann

doi:10.1007/978-94-007-0834-1_2

Cited by 1 publication

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“…For example, despite the general disapproval of antipsychotic polypharmacy, it has been argued that augmentation of olanzapine with another antipsychotic is generally advantageous (Zink 2005). Adding lithium or anticonvulsant drugs has been studied to the point of systematic review and meta-analysis (Mortimer 2011), with generally disappointing results in groups of patients, although there have been positive individual trials, particularly with sodium valproate, lamotrigine and topiramate. There is some very limited evidence of the efficacy of non-steroidal anti-inflammatory drugs, whose theoretical therapeutic mechanism suggests that their advantages will be limited to the early stages of schizophrenia ).…”

Section: Persistent Positive Symptomsmentioning

confidence: 99%

Using clozapine in clinical practice

Mortimer¹

2011

Adv. psychiatr. treat

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SummaryClozapine remains underutilised as the only antipsychotic for treatment-resistant schizophrenia, despite liberal National Institute for Health and Clinical Excellence guidelines for its consideration. Bearing in mind its monitoring requirements and poor tolerability, suggestions are made for patients who fail to improve on other antipsychotic drugs. Clozapine may be offered to apparently unsuitable patients, although this is fraught with difficulty. A realistic appraisal of the alternatives is essential in this situation. Optimising plasma clozapine levels, alongside the use of rehabilitative interventions and adjuncts as necessary, will maximise efficacy, and there are numerous options to minimise side-effects. Clozapine requires a lengthier trial than other antipsychotics and discontinuation should be avoided if possible, as the results are generally very poor. Established successful clozapine treatment can induce substantial functional gains which accrue with time: patients are retained in treatment and relapse is prevented. Such optimal outcomes justify the initial effort expended by all.

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Section: Persistent Positive Symptomsmentioning

confidence: 99%