The appearance of inhibitory symptoms encompassed in what are known as negative symptoms is part of the usual symptoms of schizophrenia. Sometimes this inhibition reaches a significant severity, so it is essential to know its approach.

Case report and literature review regarding the treatment of resistant schizophrenia with a predominance of negative symptoms

We present the clinical case of a 28-year-old man diagnosed with schizophrenia at 23 years old, whose onset was characterized by delusional ideas of harm (poisoning) and delusions with a mystic-religious theme that lead him to reduce his intake until requiring a first admission for severe desnutrition. Subsequently, after two more admissions, the patient presents selective reduction in food intake, decrease in daily activity and apathy without positive symptoms.

Throughout the treatment, several lines of antipsychotic treatments have been tried at the maximum tolerated dose (haloperidol, oral paliperidone and depot, aripiprazole and clozapine up to a dose of 600 mg). Clozapine resistance required testing various augmentation strategies (Venlafaxine, Lamotrigine and Electroconvulsive therapy) with low results. Finally, to complement the treatment, the patient was transferred to a mid-stay unit where psychosocial treatment with a multidisciplinary approach was started. This has allowed more continuous follow-up and thus a partial improvement of the clinic.

Numerous studies describe numerous augmentation strategies for clozapine-resistant schizophrenia with negative symptoms. However, the results are still inconclusive, needing more research. Meanwhile, we want to highlight the importance of complementing the treatment with psychosocial approaches.

No significant relationships.

Several studies have shown an association between oculocutaneous albinism and several neuropsychiatric entities, including schizophrenia.

We present through this work the first case of resistant schizophrenia described in this type of patient.

Demonstrate the safety of clozapine in albinos patients and discuss the linkage between the two disorders.

We describe the case of a 23-year-old patient with oculocutaneous albinism who developed treatment-resistant schizophrenia, successfully treated with clozapine.

We received the patient referred by his private psychiatrist, after the absence of improvement despite the use of several first and second generation antipsychotics, alone and in combination, at therapeutic doses, with good compliance and for a duration of more than 3 months.

The onset of psychotic symptoms was at the age of 18 years, and the evolution was continuous.

On admission, the patient was agitated and assessment of thought content were difficult due to intellectual disorganization. The initial PANSS score was assessed at 120. The somatic examination was normal, except for generalized hypopigmentation and horizontal and rotatory nystagmus. A biological workup, MRI, and electroencephalogram revealed no abnormalities.

The diagnosis of resistant schizophrenia was retained and the patient was put on clozapine 12.5 mg/d with progressive titration to a dose of 400 mg at the 6th week, with marked improvement; the patient became motor calm, with understandable speech and adapted responses, the PANSS score at the 2nd month decreased markedly by 33 (from 120 to 87).

This case report suggests that clozapine can be safely introduced in patients with oculocutaneous albinism.

No significant relationships.

Combination different antipsyhotics with ECT in treatment resistant schizophrenia has been reported. However, the result are controversial. Our study investigated the long-term effects of combination ECT with three different antipsyhotic (haloperidol, amisulpride, olanzapine) in treatment of resistant schizophrenia.

The aims of our study were to investigated the long-term effects of combination ECT with three different antipsyhotic in treatment in resistant schizophrenia.

The clinical study was a naturalistic, prospective, open labelled, active controlled study in adult outpatients of both genders suffering from treatment resistant schizophrenia, (Dg F20) with follow-up of 2 years. The patient received amisulpride n=16 in range 50-200 mg/ mean daily doses 75,42. Haloperidol n=19, range 10-15 mg/day, mean daily doses 14,20 – 24,00. And olanzapine n=21, 5-15mg daily, mean daily doses 7,43.ECT was applied (8.0sec, and 0.8 amp) (Thymatron system IV somatic) in nine applications, twice a week. Clinical efficacy, was estimated using the ICD-10, PANNS and CGI psychometric scales.

According to the result, the most effective treatment was combinatin with olananzapine plus ECT, than haloperidol plus ECT, while amisulprid plus ECT had lower clinical efficacy. Olanzapine plus ECT, was significantly superior in all scale scores vs amisulpiride plus ECT, as well as haloperidol plus ECT except for PANSS-P (t=1,85, p>0,05). During the study, 38 of 70 patients were withdrawn due to treatment failure (n=21), side effects (n=6)and non compliance (n=11).

Our steady show that the combination of different antipsycotic and ECT, is more effective in treatment of resistant schizophrenia.