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Treatment refractory schizophrenia: how should we proceed?
1Schizophrenia Research Unit, Creedmoor Psychiatric Center, Queens, New York, USA.
The Psychiatric Quarterly
|October 30, 1998
Summary
Clozapine is effective for refractory schizophrenia patients, improving psychosis, negative symptoms, and aggression. Newer agents like risperidone show promise, with risperidone recommended before clozapine due to a better risk-benefit profile.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Conventional antipsychotics are limited for refractory schizophrenia, particularly for negative symptoms and cognitive deficits.
- Clozapine demonstrates robust efficacy in treatment-refractory schizophrenia, improving psychosis and other symptom domains.
Purpose of the Study:
- To review the efficacy of novel antipsychotic agents in refractory schizophrenia patients.
- To compare the efficacy of clozapine, olanzapine, and risperidone in treatment-refractory schizophrenia.
Main Methods:
- Literature review of studies on antipsychotic efficacy in refractory schizophrenia.
- Analysis of clinical trial data for clozapine, olanzapine, and risperidone.
Main Results:
- Clozapine shows high response rates (approx. 60%) in refractory patients, improving negative symptoms and aggression.
- Olanzapine shows limited superior efficacy over conventional agents in refractory patients.
- Risperidone demonstrates superior efficacy to conventional agents in refractory patients.
Conclusions:
- Clozapine remains a highly effective option for refractory schizophrenia.
- Risperidone may be a suitable alternative to clozapine, with a more favorable risk-benefit profile.
- A trial of risperidone is supported before clozapine in treatment algorithms for refractory schizophrenia.