When symptoms persist: choosing among alternative somatic treatments for schizophrenia

Many patients with schizophrenia continue to have significant disabling symptoms despite adequate trials of different types and doses of traditional neuroleptics. Clinicians treating these neuroleptic-resistant patients must look to other treatments in the hope of providing some relief. The literature on many of the alternative treatments is too scanty for firm conclusions. We offer criteria for deciding which treatments may warrant consideration. We review the evidence for the eight treatments we found to meet these criteria and discuss clinical points salient to their use in this population. Although not always conclusive, the data do offer clues for treatment guidelines and an approach to choosing among the available treatments is suggested.