Addressing nonresponse in schizophrenia

Atypical antipsychotics are recommended as first-line treatment for schizophrenia, but patients may have little or no response to an initial antipsychotic trial. Strategies for managing treatment nonresponse include increasing the dose, addressing nonadherence, augmenting the original medication, and switching the patient to another medication. Clozapine is recommended for patients with schizophrenia who have not responded to 2 other antipsychotic trials of adequate duration, but many physicians are hesitant to prescribe clozapine due to the complexity of the treatment regimen and the possibility of severe adverse effects. However, for patients with resistant schizophrenic symptoms, the benefits of clozapine may outweigh the risks. Data show that patients have more favorable opinions of clozapine treatment than many physicians expect. If clozapine treatment is initiated, physicians should mitigate risk by carefully monitoring and addressing side effects.