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Advances in Psychiatric Treatment (2005) 11: 101-106
© 2005 The Royal College of Psychiatrists

Management of clozapine-resistant schizophrenia

Rob W. Kerwin and Anusha Bolonna

Rob W. Kerwin is Professor and Head of the Section of Clinical Neuropharmacology at the Institute of Psychiatry (De Crespigny Park, London SE5 8AF, UK. E-mail: r.kerwin{at}iop.kcl.ac.uk). His interests lie in all aspects of antipsychotic clinical psychopharmacology. Anusha Bolonna is an honorary research fellow at the Institute, with special interest in the genetics of drug response in schizophrenia.

The incidence of treatment resistance in schizophrenia (failure to respond to antipsychotic therapy) is about 20%. Factors that may contribute to it include non-adherence (non-compliance) to treatment, comorbid conditions and medication side-effects. The National Institute for Clinical Excellence recommends that clozapine be used for schizophrenia resistant to another atypical antipsychotic. Here we focus on patients who are also resistant to clozapine given in adequate dosage for sufficient duration. Switching from clozapine to a previously untried atypical (e.g. olanzapine, risperidone, quetiapine) might be of benefit in partial treatment resistance. In more difficult cases, augmentation of clozapine with benzamides (sulpiride, amisulpride) and anti-epileptics (lamotrigine) shows some success. In extreme treatment resistance, a strategy is recommended that combines the proven best drug for the particular patient and psychosocial treatments.




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