Management of treatment-resistant patients with schizophrenia

This review will focus on three categories of poor response of patients with schizophrenia to an antipsychotic medication. The first category includes patients who continue to demonstrate positive psychotic symptoms when they receive adequate trials of an antipsychotic. These individuals may improve when their drug doses are altered or when they receive other drugs such as lithium or benzodiazepines in addition to their antipsychotic. Clozapine has been shown to result in substantial improvement in a majority of these patients. Additional evidence suggests that risperidone will also be effective in these individuals. The second category of poor responders consists of patients who are unable to tolerate the side effects of antipsychotics. These individuals may respond when they are changed to a newer antipsychotic. The third category includes patients who have persistent negative symptoms while they are treated with an antipsychotic. There is substantial evidence that these patients will demonstrate improvement in negative symptoms when they receive clozapine and risperidone as well as newer antipsychotics including olanzapine, sertindole, and quetiapine.