Psychiatr. pro Praxi, 2009; 10(4): 176-179

Treatment of resistant schizophrenia in clinical practice

MUDr. Libor Ustohal, doc. MUDr. Radovan Přikryl Ph.D
Psychiatrická klinika LF MU a FN Brno

Treatment of resistant schizophrenia is a serious medical problem. Although it does not exist its common definition, its main criterium

is failure of two treatment trials with antipsychotics from two different chemical classes in sufficient dosage and duration. The article

deals with possibilities of pseudoresistance, especially false diagnosis, comorbidity, insufficient treatment trials and non-compliance.

In the case of treatment-resistant schizophrenia we have several treatment strategies, which can be divided into pharmacological and

nonpharmacological methods. The key position keeps clozapine, which efficacy was confirmed repeatedly. Another treatment possibilities

consist of combination of antipsychotics, their augmentation and then nonpharmacological strategies, especially electroconvulsive

therapy, experimentally used repetitive transcranial magnetic stimulation and also psychotherapy.

Keywords: treatment-resistant schizophrenia, clozapine, combination of antipsychotics, augmentation of antipsychotics, ECT, rTMS.

Published: August 1, 2009  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Ustohal L, Přikryl R. Treatment of resistant schizophrenia in clinical practice. Psychiatr. praxi. 2009;10(4):176-179.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Češková E. Schizofrenie a její léčba. 2. vyd. Praha: Jessenius Maxdorf 2007: 104.
    2. Lieberman J, Jody D, Geisler S, et al. Time course and biologic correlates of treatment response in first-episode schizophrenia. Arch Gen Psychiatry 1993; 50: 369-376. Go to original source... Go to PubMed...
    3. Pantelis C, Lambert TJR. Managing patients with, ,treatment-resistant" schizophrenia. Med J Aust 2003; 178(Suppl 9): 62-66. Go to original source... Go to PubMed...
    4. Falkai P, Wobrock T, Lieberman J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Acute treatment of schizophrenia. World J Biol Psychiatry 2005; 6(3): 132-191. Go to original source... Go to PubMed...
    5. Kane J, Honigfeld G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789-796. Go to original source... Go to PubMed...
    6. Conley RR, Kelly DL. Management of treatment resistance in schizophrenia. Biol Psychiatry 2001; 50: 898-911. Go to original source... Go to PubMed...
    7. Barnes TRE, Dursun S. Treatment resistance in schizophrenia. Psychiatry 2008; 7(11): 487-490. Go to original source...
    8. Lam PTC. Treatment Resistance in Schizophrenia. The Hong Kong Medical Diary 2008; 13(2): 16-18.
    9. Illi A, Mattila KM, Kampman O, et al. Catechol-o-methyltransferase and monoamine oxidase A genotypes and drug response to conventional neuroleptics in schizophrenia. Journal of Clinical Psychopharmacology 2003; 23(5): 429-434. Go to original source... Go to PubMed...
    10. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35(2): 383-402. Go to original source... Go to PubMed...
    11. Agid O, Kapur S, Arenovich T, Zipursky RB. Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Arch Gen Psychiatry 2003; 60: 1228-1235. Go to original source... Go to PubMed...
    12. Leucht S, Busch R, Hamann J, et al. Early-onset hypothesis of antipsychotic drug action: a hypothesis tested, confirmed and extended. Biol Psychiatry 2005; 57: 1543-1549. Go to original source... Go to PubMed...
    13. Conley RR, Kelly DL, Nelson MW, et al. Risperidone, quetiapine, and fluphenazine in the treatment of patients with therapy-refractory schizophrenia. Clin Neuropharmacol 2005; 28: 163-168. Go to original source... Go to PubMed...
    14. Kerwin RW, Bolonna A. Management of clozapine-resistant schizophrenia. Advances in Psychiatric Treatment 2005; 11: 101-106. Go to original source...
    15. Chakos M, Lieberman J, Hoffman E, et al. Effectiveness of second-generation antipsychotics in patients with treatmentresistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158: 518-526. Go to original source... Go to PubMed...
    16. McEvoy JP, Lieberman JA, Stroup TS, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006; 163: 600-610. Go to original source...
    17. Lewis SW, Barnes TRE, Davies L, et al. Randomized Controlled Trial of Effect of Prescription of Clozapine Versus Other Second-Generation Antipsychotic Drugs in Resistant Schizophrenia. Schizophr Bull 2006; 32(4): 715-723. Go to original source... Go to PubMed...
    18. Meltzer HY. Treatment of the neuroleptic-nonresponsive schizophrenic patient. Schizophr Bull 1992; 185: 15-542. Go to original source... Go to PubMed...
    19. Švestka J. Clozapin. Prototyp antipsychotik nové generace. Praha: Maxdorf Jessenius 1998: 155.
    20. Correll CU, Rummell-Kluge C, Corves C, et al. Antipsychotic Combinations vs Monotherapy in Schizophrenia: A Meta-analysis of Randomized Controlled Trials. Schizophr Bull 2009; 35(2): 443-457. Go to original source... Go to PubMed...
    21. Zink M, Knopf U, Henn FA. Combination of clozapine and amisulpride in treatment-resistant schizophrenia: case reports and review of the literature. Pharmacopsychiatry 2004; 37: 26-31. Go to original source... Go to PubMed...
    22. Chang JS, Ahn YM, Park HJ, et al. Aripiprazole augmentation in clozapine-treated patients with refractory schizophrenia: an 8-week, randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2008; 69(5): 720-731. Go to original source... Go to PubMed...
    23. Tiihonen J, Wahlbeck K, Kiviniemi V. The efficacy of lamotrigine in clozapine-resistant schizophrenia: A systematic review and meta-analysis. Schizophr Res 2009; v tisku. Go to original source...
    24. Leucht S, Kissling W, McGrath J. Lithium for schizophrenia revisited: A systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry 2004; 65: 177-186. Go to original source... Go to PubMed...
    25. Citrome L, Casey DE, Daniel DG, et al. Adjunctive divalproex and hostility among patients with schizophrenia receiving olanzapine or risperidone. Psychiatr Serv 2004; 55(3): 290-294. Go to original source... Go to PubMed...
    26. Wassef A, Dott SG, Harris A. Randomized, placebo-controlled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia. J Clin Psychopharmacol 2000; 20: 357-361. Go to original source... Go to PubMed...
    27. Conley RR, Buchanan RW. Evaluation of treatment-resistant schizophrenia. Schizophr Bull 1997; 23: 663-674. Go to original source... Go to PubMed...
    28. Joy CB, Mumby-Croft R, Joy LA. Polyunsaturated fatty acid supplementation for schizophrenia. Cochrane Database Syst Rev 2003; 2: CD001257. Go to original source...
    29. Peet M, Brind J, Ramchand CN, at al. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophr Res 2001; 49: 243-251. Go to original source... Go to PubMed...
    30. Freudenreich O, Herz L, Deckerbasch T, et al. Added donepezil for stable schizophrenia: a double-blind, placebo controlled trial. Psychopharmacology 2005; 181: 358-363. Go to original source... Go to PubMed...
    31. Braga RJ, Petrides G. The combined use of electroconvulsive therapy and antipsychotics in patients with schizophrenia. J ECT 2005; 21: 75-83. Go to original source... Go to PubMed...
    32. Aleman A, Sommer IE, Kahn RS. Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis. J Clin Psychiatry 2007; 68(3): 416-421. Go to original source... Go to PubMed...
    33. Fitzgerald PB, Daskalakis ZJ. A Review of Repetitive Transcranial Magnetic Stimulation Use in The Treatment of Schizophrenia. Canadian Journal of Psychiatry 2008; 53(9): 567-576. Go to original source... Go to PubMed...
    34. Prikryl R, Kasparek T, Skotakova S, et al. Treatment of negative symptoms of schizophrenia using repetitive transcranial magnetic stimulation in a double-blind, randomized controlled study. Schizophr Res 2007; 95(1-3): 151-157. Go to original source... Go to PubMed...
    35. Skotáková S, Ustohal L, Přikryl R, Navrátilová P. Léčba sluchových halucinací pomocí repetitivní transkraniální magnetické stimulace (rTMS) aplikované na oblast temporoparietálního kortexu: kazuistické sdělení. Psychiatrie 2007; 11(Suppl 1): 33.
    36. Rathod S, Kingdon D, Weiden P, Turkington D. Cognitivebehavioral therapy for medication-resistant schizophrenia: a review. J Psychiatr Pract 2008; 14: 22-33. Go to original source... Go to PubMed...

    Return to the content


    Psychiatry for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.