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1.04 - Approach to Treatment-Resistant Schizophrenia Spectrum Patients

from Part I - Treatment Strategies

Published online by Cambridge University Press:  19 October 2021

Edited by
Michael Cummings  and
Stephen Stahl
Michael Cummings
Affiliation:
University of California, Los Angeles
Stephen Stahl
Affiliation:
University of California, San Diego
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Summary

Inadequate treatment contributes not only to poor quality of life but also to an increase in disease-related societal burdens. A small subset (20–30%) of the schizophrenia patient population are treatment-resistant and financially cost approximately ten-fold more than non-treatment-resistant schizophrenia patients [1]. Numerous ineffective antipsychotic trials continue to be prescribed while clozapine, which has widespread compelling efficacy data, continues to be underutilized in treatment-resistant schizophrenia. This chapter addresses clozapine efficacy in not only treatment-resistant psychosis but also comorbid suicidality and aggression, as well as treatment-resistant mania. Further, initiation and maintenance of clozapine treatment is summarized.

Type
Chapter
Information
Management of Complex Treatment-resistant Psychotic Disorders , pp. 22 - 33
Publisher: Cambridge University Press
Print publication year: 2021

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References

Meyer, J. M. (2019). The Clozapine Handbook. Stahl’s Handbooks. New York: Cambridge University Press.CrossRefGoogle Scholar
Kane, J., Honigfeld, G., Singer, J., et al. (1988). Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry, 45, 789–796.CrossRefGoogle ScholarPubMed
Howes, O. D., McCutcheon, R., Agid, O., et al. (2016). Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. Am J Psychiatry, 174, 216–229.CrossRefGoogle Scholar
Galling, B., Roldan, A., Hagi, K., et al. (2017). Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry, 16, 77–89.CrossRefGoogle ScholarPubMed
Stroup, T. S., Gerhard, T., Crystal, S., et al. (2015). Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia. Am J Psychiatry, 173, 166–173.CrossRefGoogle ScholarPubMed
Siskind, D., Siskind, V., Kisely, S. (2017). Clozapine Response Rates among People with Treatment-resistant Schizophrenia: Data from a Systematic Review and Meta-analysis. Los Angeles, CA: SAGE Publications.Google ScholarPubMed
Yoshimura, B., Yada, Y., So, R., et al. (2017). The critical treatment window of clozapine in treatment-resistant schizophrenia: secondary analysis of an observational study. Psychiatry Res, 250, 65–70.CrossRefGoogle ScholarPubMed
Meltzer, H. Y., Alphs, L., Green, A. I., et al. (2003). Clozapine treatment for suicidality in schizophrenia: international suicide prevention trial (InterSePT). Arch Gen Psychiatry, 60, 82–91.CrossRefGoogle ScholarPubMed
Quanbeck, C. D., McDermott, B. E., Lam, J., et al. (2007). Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatr Serv, 58, 521–528.CrossRefGoogle ScholarPubMed
Meyer, J. M., Cummings, M. A., Proctor, G., et al. (2016). Psychopharmacology of persistent violence and aggression. Psychiatr Clin North Am, 39, 541–556.CrossRefGoogle ScholarPubMed
Fazel, S., Gulati, G., Linsell, L., et al. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS Med, 6, e1000120.CrossRefGoogle ScholarPubMed
Fazel, S., Långström, N., Hjern, A., et al. (2009). Schizophrenia, substance abuse, and violent crime. JAMA, 301, 2016–2023.CrossRefGoogle ScholarPubMed
Krakowski, M. I., Czobor, P., Citrome, L., et al. (2006). Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry, 63, 622–629.CrossRefGoogle ScholarPubMed
Frogley, C., Taylor, D., Dickens, G., et al. (2012). A systematic review of the evidence of clozapine’s anti-aggressive effects. Int J Neuropsychopharmacol, 15, 1351–1371.CrossRefGoogle ScholarPubMed
Vanderwaal, F. M. (2015). Impact of motivational interviewing on medication adherence in schizophrenia. Issues Ment Health Nurs, 36, 900–904.CrossRefGoogle ScholarPubMed
Reimer, J., Kuhn, J., Wietfeld, R., et al. (2019). Motivational interviewing: a possibility for doctor-patient communication in schizophrenia? Der Nervenarzt, 90(11), 1144–1153.CrossRefGoogle ScholarPubMed

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