This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

FREE CME: ACADEMIC HIGHLIGHTS

Treatment-Resistant Schizophrenia: Definition, Predictors, and Therapy Options

Treatment-resistant schizophrenia (TRS) represents a major clinical challenge. The broad definition of TRS requires nonresponse to at least 2 sequential antipsychotic trials of sufficient dose, duration, and adherence. Several demographic, clinical, and neurologic predictors are associated with TRS. Primary (or early) TRS is present from the beginning of therapy, while patients with secondary (or later-onset) TRS initially respond to antipsychotics but become resistant over time, often after relapses. Guidelines worldwide recognize clozapine as the most effective treatment option for TRS, but clozapine is underused due to various barriers. Importantly, studies indicate that response rates are higher when clozapine is initiated earlier in the treatment course. Side effects are common with clozapine, particularly in the first few weeks, but can mostly be managed without discontinuation; they do require proactive assessment, intervention, and reassurance for patients. Furthermore, plasma leucocyte and granulocyte levels must be monitored weekly during the first 18–26 weeks of treatment, and regularly thereafter, according to country regulations. Therapeutic drug monitoring of clozapine trough plasma levels is helpful to guide dosing, with greatest efficacy at plasma clozapine levels ≥350 µg/L, although this level is not universal. Notably, plasma clozapine levels are generally greater at lower doses in nonsmokers, patients with heavy caffeine consumption, in women, in obese people, in those with inflammation (including COVID-19 infection), and in older individuals. Earlier and broader use of clozapine in patients with TRS is an important measure to improve outcomes of patients with this most severe form of the illness.


PDF version of article
Note: To receive credit, you must navigate through the entire online activity. Click link below.

See the entire activity

To cite: Correll CU, Howes OD. Treatment-resistant schizophrenia: definitions, predictors, and therapy options. J Clin Psychiatry. 2021;82(5):MY20096AH1C.
To share: https://doi.org/10.4088/JCP.MY20096AH1C

© Copyright 2021 Physicians Postgraduate Press, Inc.

aZucker School of Medicine at Hofstra/Northwell, Hempstead, New York
bInstitute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK

 

Volume: 82

Quick Links: Schizophrenia and Schizoaffective Disorders

References

Sign-up to stay
up-to-date today!

SUBSCRIBE

Already registered? Sign In

Letter to the Editor

How to Reliably Predict Relapse After Electroconvulsive Therapy?

Lambrichts and colleagues respond to Dr Andrade’s recent Clinical and Practical Psychopharmacology article commenting on their study...

Read More...