The practical management of refractory schizophrenia - the Maudsley Treatment REview and Assessment Team service approach

Abstract

The service had increased the number of patients receiving community assessment and initiation of clozapine by five-fold relative to the rate prior to the establishment of the service. The large number of referrals and high attendance rate indicates that there is clinical demand for the model. Systematic evaluation is required to determine the clinical and cost-effectiveness of this model and its potential application to other clinical settings.

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

“…These factors should prompt consideration for the provision of more dedicated hospital and community facilities to allow for the successful completion of the early stages of clozapine use, with adequate supported accommodation provided as required, to enable continued clozapine use. There is some evidence that such an approach is effective in increasing access to clozapine (Beck et al, 2014).…”

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine

“…Although there is no consensus on what proportion of patients should be treated with clozapine, all patients with treatment-refractory schizophrenia should be offered clozapine unless there is an absolute contraindication, such as history of myocarditis or clozapine-induced agranulocytosis (20). Estimates indicate that up to 30% of patients with schizophrenia are considered treatment resistant, but not all patients with treatment-resistant schizophrenia are appropriate candidates for or are willing to take clozapine, Therefore, one could estimate that the percentage of patients with schizophrenia who use clozapine should approach 20%.…”

Targeting glutamate to treat schizophrenia: lessons from recent clinical studies

“…However, as they all essentially use the same common mechanism of action, D2 antagonism, from a mechanistic perspective, there is little choice (Howes and Kapur 2009). This is a problem because one third of patients do not respond to standard medications (Beck et al 2014), and the drugs have limited efficacy for negative and cognitive symptoms. This is not surprising as both treatment resistance and negative and cognitive symptoms seem to involve other neurotransmitter systems (Mouchlianitis et al 2015).…”