Refractory schizophrenia and atypical antipsychotics

@article{Taylor2000RefractorySA,
  title={Refractory schizophrenia and atypical antipsychotics},
  author={David Taylor and David Taylor and Denise Duncan-McConnell},
  journal={Journal of Psychopharmacology},
  year={2000},
  volume={14},
  pages={409 - 418}
}
Treatment resistant or refractory schizophrenia is a difficult to define condition of largely unknown prevalence. For 10 years, clozapine has been the standard treatment in this condition and is recognized unequivocally as being effective. However, clozapine is sometimes poorly tolerated and has the potential for severe toxicity. Partly as a result of this, other atypicals have recently been evaluated as treatments for refractory schizophrenia. In order to evaluate the evidence base relating to… 
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73 Citations
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73 Citations

Augmenting Clozapine Response in Treatment-Resistant Schizophrenia
TLDR
The present chapter focuses on controlled evidence available to guide clinical decision making in the face of clozapine partial response, and underscores the need for substantially more work along these lines.
Drugs in development for the treatment of schizophrenia
  • R. Emsley
  • Psychology, Medicine
    Expert opinion on investigational drugs
  • 2009
TLDR
An up-to-date review of antipsychotic drugs currently in development, focusing on the findings to date for compounds that are presently in Phase III clinical trials, suggests several drugs in early development have great potential.
Targets for treating the full spectrum of symptoms of schizophrenia
TLDR
An up-to-date review of antipsychotic drugs currently in development, focusing on the findings to date for compounds that are presently in Phase III clinical trials, suggests several drugs in early development have great potential.
New therapeutic strategies for resistance to clozapine and treatment-resistant schizophrenia
TLDR
This chapter focuses on the novel and promising agents or techniques that have recently emerged as adjunctive treatments, such as lamotrigine, memantine and cognitive-behavioral therapy, for partial responders to clozapine.
Clozapine combined with different antipsychotic drugs for treatment-resistant schizophrenia.
TLDR
There were some significant differences between clozapine combination strategies for global and mental state (clinically significant response and change), and there were data for leaving the study early and weight gain, but no data for service utilisation and quality of life.
Update : Risperidone in the Treatment of schizophrenia
TLDR
No other antipsychotic drug has shown superior clinical effectiveness in the treatment of psychotic disorders, with the significant exception of clozapine, and the wide use of risperidone in the last 15 years has confirmed a favorable safety index.
pharmacotherapy Update: Risperidone in the Treatment of schizophrenia
TLDR
No other antipsychotic drug has shown superior clinical effectiveness in the treatment of psychotic disorders, with the significant exception of clozapine, and the wide use of risperidone in the last 15 years has confirmed a favorable safety index.
Clinical Course, Neurobiology and Therapeutic Approaches to Treatment Resistant Schizophrenia. Toward an Integrated View
TLDR
Emerging evidence from TRS imaging and genetic literature that implicates dysregulation in several neurotransmitters, particularly dopamine and glutamate, and in addition genetic and neural alterations that concertedly may lead to the formation of TRS are emphasized.
Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion
TLDR
A review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment, resulting in improvement that allowed discharge from the forensic hospital.
Atypical antipsychotics: revolutionary or incremental advance?
TLDR
The quest to replace clozapine has pointed out the limitations of treatments for refractory patients, but has made available a variety of second generation antipsychotics that have raised expectations and hold promise for the treatment of the nonpsychotic patient with mood dysregulation or acute agitation.
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References

SHOWING 1-10 OF 62 REFERENCES
Olanzapine in treatment-refractory schizophrenia: results of an open-label study. The Spanish Group for the Study of Olanzapine in Treatment-Refractory Schizophrenia.
TLDR
This open study suggests that olanzapine may be effective and well tolerated for a substantial number of neuroleptic-resistant schizophrenic patients.
Treatment-resistant schizophrenia--the role of clozapine.
  • H. Meltzer
  • Psychology, Medicine
    Current medical research and opinion
  • 1997
TLDR
During the first months and years after the diagnosis of schizophrenia, clinicians should be especially alert in identifying a patient as treatment resistant in order to diminish the severe social disability and suicidality which may ensue if it is not recognised and correctly treated.
A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.
TLDR
For patients with refractory schizophrenia and high levels of hospital use, clozapine was somewhat more effective than haloperidol and had fewer side effects and similar overall costs.
An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia
TLDR
Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia and there was an overall statistically significant reduction in all parameters, especially positive symptoms, implying a favourable outcome.
Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine.
TLDR
In this relatively brief study, the apparently increased comparative risk of agranulocytosis requires that the use of clozapine be limited to selected treatment-resistant patients.
Newer atypical antipsychotic medication versus clozapine for schizophrenia.
TLDR
Social functioning was better in patients on newer atypical medication (risperidone) than in those on clozapine, but this finding is based on a single underpowered trial and has to be interpreted with caution.
Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia∗ ∗ See accompanying Editorial, in this issue.
Efficacy of risperidone in reducing positive and negative symptoms in medication-refractory schizophrenia: an open prospective study.
TLDR
Evidence is offered that risperidone may reduce positive symptoms of schizophrenia for a subgroup of chronically hospitalized schizophrenic patients who have not responded to conventional neuroleptics.
Switching from clozapine to olanzapine in treatment-refractory schizophrenia: safety, clinical efficacy, and predictors of response.
TLDR
In this open trial, the crossover from clozapine to olanzapine was generally well tolerated and resulted in a successful transition for 8 of the 19 patients, however, mean scores on the total BPRS and negative symptom and depressive symptom subscales significantly increased.
Treatment-resistant schizophrenic patients respond to clozapine after olanzapine non-response
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