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2 - Addressing Clozapine Positive Symptom Nonresponse in Schizophrenia Spectrum Patients

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer  and
Stephen M. Stahl
Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Clozapine provides the best option for treatment-resistant schizophrenia patients, but at least 40% will have suboptimal response. Although numerous adjunctive pharmacological strategies have been explored in clozapine nonresponders, none present a compelling picture of superior outcomes. Echoing this sentiment, a 2015 review on biological approaches notes that improvement is modest with medication strategies, although electroconvulsive therapy (ECT) is more promising despite the paucity of controlled studies. These conclusions may engender a certain amount of therapeutic nihilism; however, before deciding that clozapine is ineffective and embarking on a litany of adjunctive options, there is a short list of strategies that may convert nonresponders into responders. Given the tepid response to adjunctive options, the best hope for most patients is optimizing clozapine exposure through assessment of plasma levels and addressing tolerability issues that impose barriers to titration.

Type
Chapter
Information
The Clozapine Handbook
Stahl's Handbooks
 , pp. 44 - 59
Publisher: Cambridge University Press
Print publication year: 2019

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