Clinical aspects of super-refractory schizophrenia: a 6-month cohort observational study

Abstract

Clinical aspects of super-refractory schizophrenia: a 6-month cohort observational study Aspetos clínicos da esquizofrenia super-refratária: estudo observacional de coorte com seguimento de seis meses A b s t r a c t Objective: Approximately 30% of treatment-resistant schizophrenic patients do not fully respond to Clozapine and such patients are termed Clozapine non-responders or super-refractory schizophrenics. The aim of this study was to characterize patients with super-refractory schizophrenia according to demographic and psychopathological variables, as compared with patients with refractory schizophrenia or non-refractory subjects. Method: One hundred and two outpatients meeting DSM-IV criteria for schizophrenia were followed-up for 6 months. Subjects were classified into 3 groups: non-refractory (n = 25), refractory (n = 43) and super-refractory (n = 34). Psychopathology was assessed by the Positive and Negative Syndrome Scale, the Schedule for Deficit Syndrome, the Calgary Depression Scale and the Quality of Life Scale. Patients were rated at 2-month intervals. Results: Higher levels of severity at the disease onset as well as higher severity of positive symptoms were found to be predictive of superrefractoriness.

<p>The CYP2C19*2 and CYP2C19*17 Polymorphisms Influence Responses to Clozapine for the Treatment of Schizophrenia</p>

“…[7][8][9] For this condition, treatments are combined with CLZ and other antipsychotics, antidepressants or mood stabilizers. 10,11 Factors such as ethnicity, co-medication, age, gender, diet, as well as genetic variability to cellular receptors and drug metabolism, have been shown to affect CLZ responses. [12][13][14] With regards to TRS and SRS genetic components, variability in cytochrome P450 (CYP) enzyme activities have been described as significant in influencing CLZ bioavailability.…”

Modeling Approach with Therapeutic Drug Monitoring Data to Describe Time Course of Clozapine Exposure and Positive and Negative Syndrome Scale Scores

“…Although clozapine is the drug of choice for patients with treatment-resistant SCZ, approximately 30% of these patients did not fully respond to clozapine. 48 Accordingly, there was a tendency for the PANSS score to increase in some patients in our study. Therefore, we conclude that using only the drug effect model to describe the time course of PANSS scores after clozapine treatment was insufficient.…”

Place of the partial dopamine receptor agonist aripiprazole in the management of schizophrenia in adults: a Delphi consensus study

“…Perhaps up to half of patients with treatment-resistant schizophrenia (TRS) do not respond satisfactorily to clozapine [ 129 ] and these patients often have particularly severe disease [ 130 ]. Although a number of strategies have been proposed for treating patients with TRS who do not respond to clozapine, including augmentation with other antipsychotics, there is no consensus on which strategy represents the most beneficial approach [ 131 – 133 ].…”