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When Clozapine Fails: Augmentation Strategies in the Management of Clozapine-Resistant Schizophrenia

  • Domenico De BerardisEmail author
  • Michele Fornaro
  • Annalisa Anastasia
  • Federica Vellante
  • Alessandro Valchera
  • Marilde Cavuto
  • Giampaolo Perna
  • Marco Di Nicola
  • Gianluca Serafini
  • Alessandro Carano
  • Maurizio Pompili
  • Laura Orsolini
  • Carmine Tomasetti
  • Gabriella Di Emidio
  • Giovanni Martinotti
  • Massimo Di Giannantonio
Chapter

Abstract

Schizophrenia is a chronic and debilitating illness affecting about 0.5% of the population. Antipsychotics are the mainstay of the pharmacological treatment of such burdensome condition, although documented that roughly 20% up to 60% of the patients with schizophrenia do not respond sufficiently to conventional treatments. These patients may have a good response when clozapine is introduced with a great efficacy often seen in everyday clinical practice. However, it has been estimated that around 40–70% of patients with ascertained treatment-resistant schizophrenia receiving clozapine may have an incomplete remission and are referred to as “ultra-resistant” or “refractory.” Clozapine-resistant schizophrenia represents a challenge for the clinician and a misfortune for the patients, and several strategies have been proposed to overcome this problem, yet, to date, it remains high-bar goal. The aim of this chapter was to provide an overview of the managing strategies of clozapine-resistant schizophrenia with a particular focus on augmentation strategies aimed to improve efficacy on schizophrenia symptoms.

Keywords

Clozapine Refractory Ultra-resistant Augmentation Add-on Efficacy Tolerability 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Domenico De Berardis
    • 1
    • 2
    Email author
  • Michele Fornaro
    • 3
    • 4
  • Annalisa Anastasia
    • 4
  • Federica Vellante
    • 2
  • Alessandro Valchera
    • 3
    • 5
  • Marilde Cavuto
    • 6
  • Giampaolo Perna
    • 7
    • 8
    • 9
  • Marco Di Nicola
    • 10
  • Gianluca Serafini
    • 11
  • Alessandro Carano
    • 12
  • Maurizio Pompili
    • 13
  • Laura Orsolini
    • 3
    • 14
  • Carmine Tomasetti
    • 15
  • Gabriella Di Emidio
    • 16
  • Giovanni Martinotti
    • 2
    • 14
  • Massimo Di Giannantonio
    • 2
  1. 1.National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and TreatmentHospital “G. Mazzini”TeramoItaly
  2. 2.Department of Neuroscience, Imaging and Clinical ScienceUniversity “G. D’Annunzio”ChietiItaly
  3. 3.Polyedra Research GroupTeramoItaly
  4. 4.Department of Neuroscience, Reproductive Science and OdontostomatologySchool of Medicine ‘Federico II’ NaplesNaplesItaly
  5. 5.Villa S. Giuseppe Hospital, Hermanas HospitalariasAscoli PicenoItaly
  6. 6.Department of Theory, Analysis, Composition and DirectionMusic Conservatory “L. Canepa”SassariItaly
  7. 7.Department of Clinical NeurosciencesHermanas Hospitalarias, FoRiPsi, Villa San Benedetto MenniComoItaly
  8. 8.Department of Psychiatry and NeuropsychologyUniversity of MaastrichtMaastrichtThe Netherlands
  9. 9.Department of Psychiatry and Behavioral Sciences, Leonard Miller School of MedicineUniversity of MiamiCoral GablesUSA
  10. 10.Institute of Psychiatry and PsychologyCatholic University of Sacred HeartRomeItaly
  11. 11.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of PsychiatryUniversity of GenoaGenoaItaly
  12. 12.NHS, Department of Mental Health, Psychiatric Service of Diagnosis and TreatmentHospital “Madonna Del Soccorso”San Benedetto del TrontoItaly
  13. 13.Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea HospitalSapienza University of RomeRomeItaly
  14. 14.Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane CampusUniversity of HertfordshireHatfieldUK
  15. 15.NHS, Department of Mental Health, Psychiatric Service of Diagnosis and TreatmentHospital of GiulianovaTeramoItaly
  16. 16.NHS, Department of Mental Health, Psychiatric Service of Diagnosis and TreatmentMental Health Center of GiulianovaTeramoItaly

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