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Clozapine Combinations in Treatment-Resistant Schizophrenia Patients

  • Vladimir Lerner
  • Chanoch Miodownik
Chapter

Abstract

Schizophrenia is a severe disabling mental illness affecting about 1% of the population throughout the world. Antipsychotic medications (conventional and atypical antipsychotics) are the pharmacological basis for the cure of schizophrenia and schizoaffective patients, however not all patients are positively affected by this treatment. One fifth to one third of people suffering from schizophrenia is considered as treatment resistant. In other words, these people have persistent psychotic symptoms and poor functioning despite adequate treatment with conventional or novel antipsychotics.

To date one of the most effective medications is clozapine, which produces clinically significant improvement of symptoms in 30–50% of patients receiving it. However, from one-third to two thirds of schizophrenia patients still have persistent ‘positive’ symptoms despite adequate dosage and duration of clozapine monotherapy.

Among treatment-resistant schizophrenia patients with poor response to an adequate trial of clozapine monotherapy, 30–50% are treated with a combination of clozapine and second psychotropic medication.

Clinicians usually prescribe a combination of antipsychotics, in order to reach a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy.

In this chapter, we present a summary of the literature concerning the combination of clozapine with different psychotropic medications or procedure in management of resistant schizophrenia and schizoaffective patients.

Keywords

Negative Symptom Antipsychotic Medication Schizophrenia Patient Brief Psychiatric Rate Scale Brief Psychiatric Rate Scale Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

bid

Twice a day

BMI

Body mass index

BPRS

Brief psychiatric rating scale

CIS

Clozapine-induced hypersalivation

CYP1A2

Cytochrome P450 1A2

ECT

Electroconvulsive therapy

EEG

Electroencephalography

EPS

Extrapyramidal symptoms

FACT-Sz

Functional assessment for comprehensive treatment of schizophrenia

FGAs

First-generation antipsychotics

GABA

Gamma aminobutiric acid

GAS

Global assessment scale

HoNOS-Rome

Health of the nation outcome scales (a new Italian version of the HoNOS)

HDL

High-density lipoprotein

HRSD

Hamilton rating scale for depression

LDL

Low-density lipoprotein

MMSE

Mini-mental status examination

MRI

Magnetic resonance imaging

NMDA

N-Methyl-D-aspartate

NMDAR

N-Methyl-D-aspartate receptor

PANSS

Positive and negative syndrome scale

PSP

Personal and social performance scale

RCT

Randomized controlled study

SANS

Scale for the assessment of negative symptoms

SAPS

Scale for the assessment of positive symptoms

SGAs

Second-generation antipsychotics

SSRI

Selective serotonin re-uptake inhibitor

TRS

Treatment-resistant schizophrenia

WBC

White blood cells

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Ministry of Health, Faculty of Health SciencesBen Gurion University of the Negev and Be’er Sheva Mental Health CenterBe’er-ShevaIsrael

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