Clozapine Augmentation in Clozapine Resistant Schizophrenia – Quick Review
Up to 30% of patients with schizophrenia are classed as non-responders to antipsychotics. [Hasan et al., 2012].
A recent international collaborative (Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) has produced suggested treatment resistance criteria, summarised in the table below. [Howes et al., 2017]
There are three key tenets.
- Confirmed diagnosis – Schizophrenia was diagnosed using validated criteria, and the presence of co-morbidities was evaluated and taken into consideration.
- Adequate treatment – Sequential treatment with two different antipsychotics at the minimum effective dose over a duration of at least 6 weeks [NICE Guidelines 2014].
- Adherence – Persistence of symptoms despite treatment adherence; non-adherence is a significant issue, and therefore, at least one long-acting injectable formulation is required.
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., … & Tran, N. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry, 50(5), 410-472.