Clozapine resistant schizophrenia: Newer avenues of management

被引:37
作者
Chakrabarti, Subho [1 ]
机构
[1] Postgrad Inst Med Educ & Res, Dept Psychiat, Sect 12, Chandigarh 160012, India
关键词
Clozapine-resistance; Augmentation; Medications; Electroconvulsive therapy; Psychosocial treatments; Schizophrenia; COGNITIVE-BEHAVIORAL THERAPY; ACTING INJECTABLE ANTIPSYCHOTICS; OLANZAPINE PAMOATE DEPOT; AUGMENTATION STRATEGIES; ELECTROCONVULSIVE-THERAPY; REFRACTORY SCHIZOPHRENIA; TREATMENT RESPONSE; 2ND-GENERATION ANTIPSYCHOTICS; DISCONTINUING CLOZAPINE; NATIONWIDE COHORT;
D O I
10.5498/wjp.v11.i8.429
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
About 40%-70% of the patients with treatment-resistant schizophrenia have a poor response to adequate treatment with clozapine. The impact of clozapine-resistant schizophrenia (CRS) is even greater than that of treatment resistance in terms of severe and persistent symptoms, relapses and hospitalizations, poorer quality of life, and healthcare costs. Such serious consequences often compel clinicians to try different augmentation strategies to enhance the inadequate clozapine response in CRS. Unfortunately, a large body of evidence has shown that antipsychotics, antidepressants, mood stabilizers, electroconvulsive therapy, and cognitive-behavioural therapy are mostly ineffective in augmenting clozapine response. When beneficial effects of augmentation have been found, they are usually small and of doubtful clinical significance or based on low-quality evidence. Therefore, newer treatment approaches that go beyond the evidence are needed. The options proposed include developing a clinical consensus about the augmentation strategies that are most likely to be effective and using them sequentially in patients with CRS. Secondly, newer approaches such as augmentation with long-acting antipsychotic injections or multi-component psychosocial interventions could be considered. Lastly, perhaps the most effective way to deal with CRS would be to optimize clozapine treatment, which might prevent clozapine resistance from developing. Personalized dosing, adequate treatment durations, management of side effects and non-adherence, collaboration with patients and caregivers, and addressing clinician barriers to clozapine use are the principal ways of ensuring optimal clozapine treatment. At present, these three options could the best way to manage CRS until research provides more firm directions about the effective options for augmenting clozapine response.
引用
收藏
页码:429 / 448
页数:20
相关论文
共 151 条
[71]   In the aftermath of clozapine discontinuation: comparative effectiveness and safety of antipsychotics in patients with schizophrenia who discontinue clozapine [J].
Luykx, Jurjen J. ;
Stam, Noraly ;
Tanskanen, Antti ;
Tiihonen, Jari ;
Taipale, Heidi .
BRITISH JOURNAL OF PSYCHIATRY, 2020, 217 (03) :498-505
[72]   Paliperidone Palmitate for Refractory and Clozapine-Resistant Schizophrenia [J].
Maia-de-Oliveira, Joao Paulo ;
Nunes, Emerson Arcoverde ;
Ushirohira, Juliana Mayumi ;
Machado-de-Sousa, Joao Paulo ;
Bressan, Rodrigo Affosenca ;
Cecilio Hallak, Jaime Eduardo .
JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES, 2015, 27 (01) :E14-E16
[73]   Long-Acting Injectable Antipsychotics: Recommendations for Clinicians [J].
Malla, Ashok ;
Tibbo, Phil ;
Chue, Pierre ;
Levy, Emmanuelle ;
Manchanda, Rahul ;
Teehan, Michael ;
Williams, Richard ;
Iyer, Srividya ;
Roy, Marc-Andre .
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE, 2013, 58 (05) :30S-35S
[74]   Clozapine tolerability in Treatment Resistant Schizophrenia: exploring the role of sex [J].
Martini, Francesca ;
Spangaro, Marco ;
Buonocore, Mariachiara ;
Bechi, Margherita ;
Cocchi, Federica ;
Guglielmino, Carmelo ;
Bianchi, Laura ;
Sapienza, Jacopo ;
Agostoni, Giulia ;
Mastromatteo, Antonella ;
Bosia, Marta ;
Cavallaro, Roberto .
PSYCHIATRY RESEARCH, 2021, 297
[75]  
Masoudzadeh A, 2007, Pak J Biol Sci, V10, P4287, DOI 10.3923/pjbs.2007.4287.4290
[76]   Efficacy of electroconvulsive therapy augmentation for partial response to clozapine: a pilot randomized ECT - sham controlled trial [J].
Melzer-Ribeiro, Debora Luciana ;
Rigonatti, Sergio Paulo ;
Kayo, Monica ;
Avrichir, Belquiz S. ;
Ribeiro, Rafael Bernardon ;
dos Santos, Bernardo ;
Fortes, Marisa ;
Elkis, Helio .
ARCHIVES OF CLINICAL PSYCHIATRY, 2017, 44 (02) :45-50
[77]   Schizophrenia: when clozapine fails [J].
Miyamoto, Seiya ;
Jarskog, Lars Fredrik ;
Fleischhacker, W. Wolfgang .
CURRENT OPINION IN PSYCHIATRY, 2015, 28 (03) :243-248
[78]  
Moeller F G, 1995, Ann Clin Psychiatry, V7, P167, DOI 10.3109/10401239509149622
[79]   Cognitive behavioural therapy in clozapine-resistant schizophrenia (FOCUS): an assessor-blinded, randomised controlled trial [J].
Morrison, Anthony P. ;
Pyle, Melissa ;
Gumley, Andrew ;
Schwannauer, Matthias ;
Turkington, Douglas ;
MacLennan, Graeme ;
Norrie, John ;
Hudson, Jemma ;
Bowe, Samantha E. ;
French, Paul ;
Byrne, Rory ;
Syrett, Suzy ;
Dudley, Robert ;
McLeod, Hamish J. ;
Griffiths, Helen ;
Barnes, Thomas R. E. ;
Davies, Linda ;
Kingdon, David .
LANCET PSYCHIATRY, 2018, 5 (08) :633-643
[80]   Augmentation strategies of clozapine with antipsychotics in the treatment of ultraresistant schizophrenia [J].
Mouaffak, F ;
Tranulis, C ;
Gourevitch, R ;
Poirier, MF ;
Douki, S ;
Olié, JP ;
Lôo, H ;
Gourion, D .
CLINICAL NEUROPHARMACOLOGY, 2006, 29 (01) :28-33