Refractory schizophrenia and atypical antipsychotics

Abstract

Treatment resistant or refractory schizophrenia is a difficult to define condition of largely unknown prevalence. For 10 years, clozapine has been the standard treatment in this condition and is recognized unequivocally as being effective. However, clozapine is sometimes poorly tolerated and has the potential for severe toxicity. Partly as a result of this, other atypicals have recently been evaluated as treatments for refractory schizophrenia. In order to evaluate the evidence base relating to the drug treatment of refractory schizophrenia, we developed a refractoriness rating based on previous work. Using this rating, we assessed all trials of atypicals in schizophrenia unresponsive to at least one drug. Overall, clozapine was consistently shown to be effective in refractory schizophrenia, even when stringently defined. Data relating to olanzapine and risperidone are equivocal at best, and there is some evidence to suggest that they are less effective than clozapine. There is essentially no cogent evidence to support the use of any other atypical in refractory schizophrenia. Clozapine remains the drug of choice in this condition.

Augmentation of atypical antipsychotics with valproic acid. An open‐label study for most difficult patients with schizophrenia

“…In particular, resistant patients are cited as one of the targets for such a strategy (Schwarz et al, 2008). In addressing effectiveness of augmentation for difficult patients, how to define treatment refractoriness is critically relevant (Taylor and Duncan-McConnell, 2000). And clinical evidence for augmentation with anticonvulsants is still sparse (Citrome, 2009).…”

Regelbehandlung mit Antipsychotika ist nicht ausreichend effektiv

“…B. [24,25,26,27]); auch bei nicht therapieresistenten Fällen zeigen sich zumindest tendenzielle Vorteile von Clozapin allen andere Antipsychotika gegenüber (siehe weiter oben referierte metaanalytische Ergebnisse). Ganz besonders e ektiv ist es, Clozapin plasmaspiegelgesteuert einzusetzen.…”

Evaluation of an antipsychotic information sheet for patients

“…With the exception of clozapine, there are no major differences between antipsychotics in overall efficacy [8,9], but atypical agents are thought to have improved tolerability compared with the typical antipsychotics [10]. However, there are no certainties that a particular patient will respond to a specific antipsychotic as response is individual.…”