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Management of Treatment Resistant Schizophrenia Unresponsive to Clozapine

Published online by Cambridge University Press:  06 August 2018

Thomas R. E. Barnes ,
Christopher J. B. McEvedy  and
Hazel E. Nelson
Thomas R. E. Barnes*
Affiliation:
Department of Psychiatry, Charing Cross and Westminster Medical School
Christopher J. B. McEvedy
Affiliation:
Department of Psychiatry, Charing Cross and Westminster Medical School
Hazel E. Nelson
Affiliation:
Department of Psychiatry, Charing Cross and Westminster Medical School
*
Professor T. R. E Barnes, Department of Psychiatry, Charing Cross and Westminster Medical School, St Dunstan's Road, London W6 8RP
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Extract

A recent challenge in schizophrenia has been the management of patients who have failed to respond not only to standard therapeutic regimes but also to trials of atypical neuroleptics such as clozapine and risperidone. This article focuses on the further psychological and pharmacological management of such patients.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 169 , Issue S31: Management of Difficult to Treat Patients with Schizophrenia , December 1996 , pp. 31 - 40
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Abraham, K. R. & Kulhara, P. (1987) The efficacy of electroconvulsive therapy in the treatment of schizophrenia. British Journal of Psychiatry, 151, 152–155.CrossRefGoogle ScholarPubMed
Arana, G. W., Goff, D. C., Frieman, H., et al (1986) Does carbamazepine induced reduction of plasma haloperidol levels worsen psychotic symptoms? American Journal of Psychiatry, 143, 650–651.Google ScholarPubMed
Babiker, I. E. (1986) Noncompliance in schizophrenia. Psychiatric Developments, 4, 329–337.Google ScholarPubMed
Baldessarini, R. J., Kando, J. C. & Centorrino, F. (1995) Hospital use of antipsychotic agents in 1989 and 1993; stable dosing with decreased length of stay. American Journal of Psychiatry, 152, 1038–1044.Google ScholarPubMed
Bebbington, P. E. (1995) The content and context of compliance. International Clinical Psychopharmacology, 9 (Suppl. 5), 41–50.Google Scholar
Bowen, J. & Barnes, T. R. E. (1994) The clinical characteristics of schizophrenic patients consenting and not consenting to a placebo-controlled trial. Human Psychopharmacology, 9, 423–433.Google Scholar
Brandon, S., Gabriel, A. R. & Impastato, D. J. (1985) Leicester ECT trial: results in schizophrenia. British Journal of Psychiatry, 146, 177–183.CrossRefGoogle ScholarPubMed
Breakey, W. R., Goodell, H., Lorenz, P. C., et al (1974) Hallucinogenic drugs as precipitants of schizophrenia. Pyschological Medicine, 4, 255–261.CrossRefGoogle ScholarPubMed
Bredbacka, P.-E., Paukkala, E., Kinnunen, E., et al (1993) Can severe cardiorespiratory dysregulation induced by clozapine monotherapy be predicted? International Clinical Psychopharmacology, 8, 205–206.CrossRefGoogle ScholarPubMed
Breier, A., Buchanan, R. W., Irish, D., et al (1993) Clozapine treatment of outpatients with schizophrenia: outcome and long-term response patterns. Hospital and Community Psychiatry, 44, 1145–1149.Google ScholarPubMed
Bryois, C. & Ferrero, F. (1993) Clinical observation of 11 patients under clozapine–lithium association. European Psychiatry, 8, 213–218.Google Scholar
Buckley, P. F., Thompson, P., Way, L., et al (1994) Substance use among patients with treatment resistant schizophrenia: characteristics and implications for clozapine therapy. American Journal of Psychiatry, 151, 385–389.Google ScholarPubMed
Carmen, J. S., Bigelow, L. B. & Wyatt, R. J. (1981) Lithium combined with neuroleptics in chronic schizophrenic and schizoaffective patients. Journal of Clinical Psychiatry, 42, 124–128.Google Scholar
Carpenter, W. T. Jnr., Kurz, R., Kirkpatrick, H. B., et al (1991) Carbamazepine maintenance treatment in outpatient schizophrenics. Archives of General Psychiatry, 48, 69–72.CrossRefGoogle ScholarPubMed
Centorrino, F., Baldessarini, R. J., Kando, J., et al (1994) Serum concentrations of clozapine and its major metabolites: effects of cotreatment with fluoxetine or valproate. American Journal of Psychiatry, 151, 123–125.Google ScholarPubMed
Chadwick, P., Birchwood, M. & Trower, P. (1996) Cognitive Therapy in Delusions, Voices and Paranoia. Chichester: Wiley.Google Scholar
Chouinard, G. (1988) The use of benzodiazepines in the treatment of manic depressive illness. Canadian Journal of Psychiatry, 49 (November supplement), 15–20.Google Scholar
Collins, P. J., Larkin, E. P. & Schubsachs, A. P. W. (1991) Lithium carbonate in chronic schizophrenia – a brief trial of lithium carbonate added to neuroleptics for treatment of resistant schizophrenic patients. Acta Psychiatrica Scandinavica, 84, 150–154.Google Scholar
Copp, P. J., Lament, R. & Tennent, T. G. (1991) Amitriptyline in clozapine-induced sialorrhoea. British Journal of Psychiatry, 159, 166.CrossRefGoogle ScholarPubMed
Csernansky, J. G., Riney, S. J., Lombroso, L., et al (1988) Double-blind comparison of alprazolam, diazepam and placebo for the treatment of negative schizophrenic symptoms. Archives of General Psychiatry, 45, 655–659.CrossRefGoogle ScholarPubMed
Devinsky, O., Honigfeld, G. & Patin, J. (1991) Clozapine-related seizures. Neurology, 41, 369–371.Google Scholar
Duke, P., Pantelis, C. & Barnes, T. R. E. (1991) South Westminster Schizophrenia Survey: substance abuse and its relationship to symptomatology (Abstract). Biological Psychiatry, 29 (Suppl.), 664.Google Scholar
Duke, P., Pantelis, C. & Barnes, T. R. E. (1994) South Westminster Schizophrenia Survey. II. Alcohol use in schizophrenia: symptomatology, relationship with tardive dyskinesia, akathisia and age at onset. British Journal of Psychiatry, 164, 630–636.CrossRefGoogle Scholar
Fink, M. (1979) Convulsive Therapy; Theory and Practice. New York: Raven Press.Google Scholar
Fink, M. (1990) Clozapine and electroconvulsive therapy. Archives of General Psychiatry, 47, 290–291.Google Scholar
Fitton, A. & Benfield, P. (1993) Clozapine: an appraisal of its pharmacoeconomic benefits in the treatment of schizophrenia. PharmacoEconomics, 4, 131–156.Google Scholar
Fowler, D., Garety, P. & Kuipers, L. (1995) Cognitive Behaviour Therapy for Psychosis. Chichester: John Wiley.Google Scholar
Friedel, R. O. (1986) The combined use of neuroleptics and ECT in drug resistant schizophrenic patients. Psychopharmacology Bulletin, 22, 928–930.Google Scholar
Green, A. I., Zalma, A., Berman, I., et al (1994) Clozapine following ECT: a two step treatment. Journal of Clinical Psychiatry, 55, 388–390.Google Scholar
Grabowski, J. (1992) Clonidine treatment of clozapine-induced hypersalivation. Journal of Psychopharmacology, 12, 69–70.CrossRefGoogle ScholarPubMed
Grohmann, R., Ruther, E., Sassim, N., et al (1989) Adverse effects of clozapine. Psychopharmacology, 99, S101–S104.Google Scholar
Growe, G. A., Crayton, J. W., Klass, D. B., et al (1979) Lithium in chronic schizophrenia. American Journal of Psychiatry, 136, 454–455.CrossRefGoogle ScholarPubMed
Gujavarty, K., Greenberg, L. B. & Fink, M. (1987) Electroconvulsive therapy and neuroleptic medication in therapy-resistant positive symptom psychosis. Convulsive Therapy, 3, 185–195.Google Scholar
Haddock, G. & Slade, P. D. (eds) (1996) Cognitive–Behavioural Interventions with Psychotic Disorders. London: Routledge.Google Scholar
Hirsch, S. R., Jolley, A. & Barnes, T. R. E. (1990) Are depressive symptoms part of the schizophrenic syndrome? In Depression in Schizophrenia (ed. DeLisi, L. E.), pp. 25–37. Washington: American Psychiatric Press.Google Scholar
Janakiramaiah, N., Channabasavanna, S. M. & Narashima Murthy, N. S. (1982) ECT/chlorpromazine combination versus chlorpromazine alone in acutely schizophrenic patients. Acta Psychiatrica Scandinavica, 66, 464–470.Google Scholar
Jann, M. W., Fidoen, G. S., Hernandez, J. M., et al (1989) Clinical implications of increased antipsychotic plasma concentrations upon anticonvulsant cessation. Psychiatry Research, 28, 153–159.CrossRefGoogle ScholarPubMed
Johns, C. A. & Thompson, J. W. (1995) Adjunctive treatments in schizophrenia: pharmacotherapies and electroconvulsive therapy. Schizophrenia Bulletin, 21, 607–619.Google Scholar
Johnson, G. G., Littrell, K. H. & Magill, A. M. H. (1994) Starting patients on clozapine in a partial hospitalisation programme. Hospital and Community Psychiatry, 43, 264–268.Google Scholar
Johnstone, E. C., Frith, C. D., Crow, T. J., et al (1988) The Northwick Park “functional” psychosis study: diagnosis and treatment response. Lancet, 2, 119–125.CrossRefGoogle ScholarPubMed
Kahn, E. M., Schulz, S. C., Perel, J. M., et al (1990) Change in haloperidol level due to carbamazepine – a complicating factor in combined medication for schizophrenia. Journal of Clinical Psychopharmacology, 10, 54–57.Google Scholar
Kando, J. C., Tohen, M., Castillo, J., et al (1994) Concurrent use of clozapine and valproate in affective and psychotic disorders. Journal of Clinical Psychiatry, 55, 255–257.Google ScholarPubMed
Kibel, D. A., Laffont, I. & Liddle, P. F. (1993) The composition of the negative syndrome of chronic schizophrenia. British Journal of Psychiatry, 162, 744–750.Google Scholar
Kingdon, D. G. & Turkington, D. (1994) Cognitive Behavioural Therapy of Schizophrenia. Hove: Lawrence Erlbaum.Google Scholar
Klein, E., Beutal, E., Lerer, B., et al (1984) Carbamazepine and haloperidol versus placebo and haloperidol in excited psychosis: a controlled study. Archives of General Psychiatry, 41, 165–170.Google Scholar
Koreen, A. R., Siris, S. G., Chakos, M., et al (1993) Depression in first-episode schizophrenia. American Journal of Psychiatry, 150, 1643–1648.Google ScholarPubMed
Kramer, B. A. (1990) Maintenance electroconvulsive therapy in clinical practice. Convulsive Therapy, 6, 279–286.Google ScholarPubMed
Lerner, Y., Mintzer, Y. & Schestatzky, M. (1988) Lithium combined with haloperidol in schizophrenic patients. British Journal of Psychiatry, 153, 359–362.CrossRefGoogle ScholarPubMed
Lingjaerde, O., Engstrand, E., Ellingsen, P., et al (1979) Antipsychotic effect of diazepam when given in addition to neuroleptics in chronic psychotic patients; a double-blind clinical trial. Current Therapeutic Research, 26, 505–514.Google Scholar
Linszen, D. H., Dingemans, P. M. & Lenior, M. E. (1994) Cannabis abuse and the course of recent onset of schizophrenic disorders. Archives of General Psychiatry, 51, 273–279.Google Scholar
Maletzky, B. M. (1973) The episodic dyscontrol syndrome. Diseases of the Nervous System, 34, 178–185.Google Scholar
Mann, J. J. (1986) How medication compliance affects outcome. Psychiatric Annals, 16, 567–570.Google Scholar
Meltzer, H. Y. (1992) Treatment of the neuroleptic non-responsive schizophrenic. Schizophrenia Bulletin, 18, 515–533.CrossRefGoogle Scholar
Miller, D. D. (1991) Effect of phenytoin on plasma clozapine concentrations in two patients. Journal of Clinical Psychiatry, 52, 23–35.Google ScholarPubMed
Milstein, V., Small, J. G., Miller, M. J., et al (1990) Mechanism of action of ECT: schizophrenia and schizoaffective disorder. Biological Psychiatry, 27, 1281–1299.Google Scholar
Mulvey, E. P. (1994) Assessing the evidence of a link between mental illness and violence. Hospital and Community Psychiatry, 45, 663–668.Google Scholar
Negrete, J. C., Knapp, W. P., Douglas, D. E., et al (1986) Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychological Medicine, 16, 515–520.Google Scholar
Nelson, H. E. (1995) Cognitive-behavioural therapy with delusions. Clinical Psychology Forum, 85, 21–23.CrossRefGoogle Scholar
Nelson, H. E., Thrasher, S. & Barnes, T. R. E. (1991) Practical ways of alleviating auditory hallucinations. British Medical Journal, 302, 327.CrossRefGoogle ScholarPubMed
Nestoros, J. N., Nair, N. P. V., Pulman, J. R., et al (1983) High doses of diazepam improve neuroleptic resistant chronic schizophrenic patients. Psychopathology, 81, 42–47.Google Scholar
Pacia, S. V. & Devinsky, O. (1994) Clozapine-related seizures: experience with 5629 patients. Neurology, 44, 2247–2249.Google Scholar
Pecknold, J. C. (1993) Survey of the adjuvant use of benzodiazepines for treating outpatients with schizophrenia. Journal of Psychiatry and Neuroscience, 18, 82–84.Google Scholar
Perry, P. J., Miller, D. D., Arndt, S. V., et al (1991) Clozapine and norclozapine plasma concentrations and clinical response of treatment-refractory schizophrenic patients. American Journal of Psychiatry, 148, 231–235.Google Scholar
Potkin, S. G., Bera, R., Gulasekeram, B., et al (1994) Plasma clozapine concentrations predict clinical response in treatment-resistant schizophrenia. Journal of Clinical Psychiatry, 55 (Suppl. 9), 133–136.Google ScholarPubMed
Povlsen, U. J., Noring, U., Fog, R., et al (1985) Tolerability and therapeutic effect of clozapine. Acta Psychiatrica Scandinavica, 71, 176–185.CrossRefGoogle Scholar
Safferman, A. Z. & Munne, R. (1992) Combining clozapine with ECT. Convulsive Therapy, 8, 141–143.Google Scholar
Salzman, C., (1980) The use of ECT in the treatment of schizophrenia. American Journal of Psychiatry, 137, 1032–1041.Google Scholar
Sajatovic, M. & Meltzer, H. Y. (1993) The effect of short-term electroconvulsive treatment plus neuroleptics in treatment-resistant schizophrenia and schizoaffective disorder. Convulsive Therapy, 9, 167–175.Google Scholar
Sassim, N. & Grohmann, R. (1988) Adverse drug reactions with clozapine and simultaneous application of benzodiazepines. Pharmacopsychiatry, 21, 306–307.Google Scholar
Schneier, F. R. & Siris, S. G. (1987) A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice. Journal of Nervous and Mental Disease, 175, 641–652.Google Scholar
Schulz, S. C., Kahn, E. M., Baker, R. W., et al (1990) Lithium and carbamazepine augmentation in treatment-refractory schizophrenia. In The Neuroleptic Nonresponsive Patient: Characterisation and Treatment (eds Angrist, B. & Schulz, S. C.), pp. 109–136. American Psychaitric Press.Google Scholar
Siris, S. G. (1993) Adjunctive medication in the maintenance treatment of schizophrenia and its conceptual implications. British Journal of Psychiatry, 163 (Suppl. 22), 66–78.Google Scholar
Siris, S. G., Adan, F., Cohen, M., et al (1988) Post-psychotic depression and negative symptoms: an investigation of syndromal overlap. American Journal of Psychiatry, 145, 1532–1537.Google Scholar
Siris, S. G., Bermanzohn, P. C., Mason, S. E., et al (1991) Antidepressant for substance-abusing schizophrenic patients: a mini review. Progress in Neuroscience, Psychopharmacology, and Biological Psychiatry, 15, 1–13.Google Scholar
Siris, S. G., Bermanzohn, P. C., Mason, S. E., et al (1994) Maintenance imipramine therapy for secondary depression in schizophrenia: a controlled trial. Archives of General Psychiatry, 51, 109–115.Google Scholar
Small, J. G., Kellams, J. J., Milstein, V., et al (1975) A placebo-controlled study of lithium combined with neuroleptics in chronic schizophrenic patients. American Journal of Psychiatry, 132, 1315–1317.Google Scholar
Smith, J. & Hucker, S. (1994) Schizophrenia and substance abuse. British Journal of Psychiatry, 165, 13–21.Google Scholar
Sramek, J., Herrera, J., Costa, J., et al (1988) A carbamazepine trial in chronic treatment-refractory schizophrenia. American Journal of Psychiatry, 145, 748–750.Google Scholar
Stevens, J. R., Bigelow, L., Denney, D., et al (1979) Telemetered EEG–EOG during psychotic behaviours of schizophrenia. Archives of General Psychiatry, 36, 251–269.Google Scholar
Stone, J. L., McDaniel, K. D., Hughes, J. R., et al (1986) Episodic dyscontrol disorder and paroxysmal EEG abnormalities: successful treatment with carbamazepine. Biological Psychiatry, 21, 208–212.Google Scholar
Taylor, P. J. & Fleminger, J. J. (1980) ECT for schizophrenia. Lancet, i, 1380–1382.Google Scholar
Toth, P. & Frankenburg, F. R. (1994) Clozapine and seizures: a review. Canadian Journal of Psychiatry, 39, 236–238.Google Scholar
Tsuang, M. T., Perkins, K. & Kronfol, Z. (1982) Subtypes of drug abuse with psychosis: demographic characteristics, clinical features and family history. Archives of General Psychiatry, 39, 141–147.Google Scholar
Van Kammen, D. P., Docherty, J. P., Marder, S. R., et al (1985) Lithium attenuates the activation-euphoria but not the psychosis induced by d-amphetamine in schizophrenia. Psychopharmacology, 87, 111–115.Google Scholar
Warner, J. P., Harvey, C. A. & Barnes, T. R. E. (1994) Clozapine and urinary incontinence. International Clinical Psychopharmacology, 9, 207–209.CrossRefGoogle ScholarPubMed
Welch, J., Manschrek, T. & Redmond, D. (1994) Clozapine induced seizures and EEG changes. Journal of Neuropsychiatry and Clinical Neuroscience, 6, 250–256.Google Scholar
Wetterling, T. (1987) Open clinical trial of carbamazepine in chronic schizophrenic inpatients. Pharmacopsychiatry, 20, 127–130.Google Scholar
Wilson, W. H. (1992) Clinical review of clozapine in a state hospital. Hospital and Community Psychiatry, 43, 700–703.Google Scholar
Wilson, W. H. (1993) Addition of lithium to haloperidol in non-affective, antipsychotic, non-responsive schizophrenia: a double blind, placebo controlled, parallel design clinical trial. Psychopharmacology, 111, 359–366.CrossRefGoogle ScholarPubMed
Wolkowitz, O. M., Breier, A., Doran, A., et al (1988) Alprazolam augmentation of the antipsychotic effects of fluphenazine in schizophrenic patients. Preliminary results. Archives of General Psychiatry, 45, 664–671.Google Scholar
Wolkowitz, O. M., Rapaport, M. H. & Pickar, D. (1990) Benzodiazepine augmentation of neuroleptics. In The Neuroleptic-Nonresponsive Patient: Characterisation and Treatment (eds Angrist, B. & Schulz, S. C.), pp. 89–108. American Psychiatric Press.Google Scholar
Wolkowitz, O. M. & Pickar, D. (1991) Benzodiazepines in the treatment of schizophrenia: a review and reappraisal. American Journal of Psychiatry, 148, 714–726.Google Scholar
Wolkowitz, O. M., Turetsky, N., Reus, V. I., et al (1992) Benzodiazepine augmentation of neuroleptics in treatment-resistant schizophrenia. Psychopharmacology Bulletin, 28, 291–295.Google Scholar
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