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. 2012 Jan;10(1):20-32.
doi: 10.4103/0973-1229.91588.

Treatment-resistant Schizophrenia: Evidence-based Strategies

Susanne Englisch  1 , Mathias Zink
Affiliations

Treatment-resistant Schizophrenia: Evidence-based Strategies

Susanne Englisch et al. Mens Sana Monogr. 2012 Jan.

Abstract

Treatment-resistant symptoms complicate the clinical course of schizophrenia, and a large proportion of patients do not reach functional recovery. In consequence, polypharmacy is frequently used in treatment-refractory cases, addressing psychotic positive, negative and cognitive symptoms, treatment-emergent side effects caused by antipsychotics and comorbid depressive or obsessive-compulsive symptoms. To a large extent, such strategies are not covered by pharmacological guidelines which strongly suggest antipsychotic monotherapy. Add-on strategies comprise combinations of several antipsychotic agents and augmentations with mood stabilizers; moreover, antidepressants and experimental substances are applied. Based on the accumulated evidence of clinical trials and meta-analyses, combinations of clozapine with certain second-generation antipsychotic agents and the augmentation of antipsychotics with antidepressants seem recommendable, while the augmentation with mood stabilizers cannot be considered superior to placebo. Forthcoming investigations will have to focus on innovative pharmacological agents, the clinical spectrum of cognitive deficits and the implementation of cognitive behavioral therapy.

Keywords: Add-on; Augmentation; Combination; Polypharmacy; Schizophrenia, Treatment resistance.

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Conflict of interest statement

Conflict of interest: S.E. has been provided with travel expenses and consultant fees from AstraZeneca, Bristol-Myers Squibb GmbH & CoKGaA, Eli-Lilly, Janssen Cilag, Lundbeck, Otsuka Pharma, Pfizer Pharma and Servier

M.Z. has received unrestricted scientific grants of German Research Foundation (DFG), ERAB (European Research Advisory Board), Pfizer Pharma GmbH, Bristol-Myers Squibb GmbH & CoKGaA, further speaker and travel support from Pfizer Pharma GmbH, Bristol-Myers Squibb GmbH & CoKGaA, Astra Zeneca, Eli-Lilly and Janssen Cilag

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