Algorithm for treatment-refractory schizophrenia

This algorithm for the treatment-refractory schizophrenia consists of nine lines. It starts from the revaluation of the diagnosis and checking the compliance. 'Apparent' non efficacy due to poor compliance must be distinguished from 'authentic' non efficacy. Patients with good compliance and non efficacy go on to the next line. Line 3 includes addition of another neurolepic, a neuroleptic in a decanoate form, addition of an anti-parkinsonian drug and reduction of the neuroleptic dose. Line 5 is the neuroleptic augmentation strategy. The options of line 7 are electroconvulsive treatment, very high-dose neuroleptics, an investigational protocol drug, and a drug-free period. Finally, line 9 includes an investigational protocol drug and a drug-free period.