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Treatment resistant schizophrenia – review and a call to action

Published online by Cambridge University Press:  27 November 2018

J. Lally Open the ORCID record for J. Lally [Opens in a new window]  and
F. Gaughran
J. Lally*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent’s University Hospital, Dublin, Ireland Department of Psychiatry, St Vincent’s Hospital Fairview, Dublin, Ireland
F. Gaughran
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
*
*Address for correspondence: Dr John Lally, PO63, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Recovery rates in schizophrenia remain suboptimal with up to one-third resistant to standard treatments, a population prevalence of 0.2%. Clozapine is the only evidenced-based treatment for treatment resistant schizophrenia (TRS), yet there are significant delays in its use or it may not be trialled, potentially impacting the chance of recovery. Better outcomes with earlier use of clozapine may be possible. There is emerging evidence that early treatment resistance is not uncommon from the earliest stages of psychosis. In this review, we provide an update on TRS, its epidemiology and its management, with a specific focus on the optimal use and timing of clozapine and augmentation strategies for the one-third of patients who do not respond to clozapine.

Keywords

Clozapineearly psychosismanagementrecoveryTRS
Type
Review Article
Information
Irish Journal of Psychological Medicine , Volume 36 , Issue 4: Psychosis: from early intervention to treatment resistance , December 2019 , pp. 279 - 291
Copyright
© College of Psychiatrists of Ireland 2018 

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