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Management of Treatment Refractory Schizophrenia

Published online by Cambridge University Press:  06 August 2018

D. P. Morrison
D. P. Morrison*
Affiliation:
Ward 5, Andrew Duncan Clinic, Royal Edinburgh Hospital, Morningside, Edinburgh
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Extract

There is a general consensus that 5–25% of schizophrenic patients are partially or totally unresponsive to antipsychotic drug therapy (Brenner et al, 1990). Agreement is needed on how to define the varying degrees of response and resistance in individual patients on conventional antipsychotic medication. Apparent “treatment resistance” may be due to noncompliance; excessive protein binding with inadequate bio-availability of the neuroleptic; an inadequate or excessive dose resulting in poor efficacy or side-effects outweighing therapeutic effects (Osser, 1989); or incorrect diagnosis.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 169 , Issue S31: Management of Difficult to Treat Patients with Schizophrenia , December 1996 , pp. 15 - 20
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Alvir, J., Lieberman, J., Safferman, A., et al (1993) Clozapine induced agranulocytosis – incidence and risk factors in the United States. New England Medical Journal, 329, 204–205.Google Scholar
Anderson, C. (1983) A psychoeducational model of family treatment for schizophrenia. In Psychosocial Intervention in Schizophrenia (eds Stierlin, H., Wynne, L. C. & Wirsching, M.), pp. 227–235. New York: Springer Verlag.Google Scholar
Atkin, K. (1994) Clozapine induced neutropenia or not? British Journal of Psychiatry, 165, 407–408.Google Scholar
Biederman, J., Lerner, Y. & Belmaker, R. H. (1979) Combination of lithium carbonate in schizoaffective disorder. Archives of General Psychiatry, 36, 327–333.Google Scholar
Birchwood, M., McMillan, J. F. & Smith, J. (1992) Early intervention. In Innovations in the Psychological Management of Schizophrenia (eds Birchwood, M. & Tarrier, N.). Chichester: Wiley.Google Scholar
Birchwood, M. & Shepherd, G. (1992) Controversies and growing points in cognitive behavioural interventions for people with schizophrenia. Psychotherapy, 20, 305–342.Google Scholar
Bratfos, O. & Haug, J. O. (1979) Comparison of sulpiride and chlorpromazine in psychoses, a double blind multicentre trial. Acta Psychiatrica Scandinavica, 60, 1–9.Google Scholar
Brenner, H. D., Dencker, S. J., Goldstein, M., et al (1990) Defining treatment refractoriness in schizophrenia. Schizophrenia Bulletin, 16, 551–561.Google Scholar
Carman, J. S., Bigelow, L. B. & Wyatt, R. J. (1981) Lithium combined with neuroleptics in chronic schizophrenia and schizoaffective patients. Journal of Clinical Psychiatry, 42, 124–128.Google ScholarPubMed
Cohen, N. J. & Cohen, N. H. (1974) Lithium carbonate, haloperidol and irreversible brain damage. Journal of the American Medical Association, 230, 1283–1287.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., et al (1982) Family management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine, 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, I. R. H. & Shanahan, W. J. (1990) Community management of schizophrenia. British Journal of Hospital Medicine, 43, 62–66.Google Scholar
Farmer, A. E. & Blewett, A. (1993) Drug treatment of resistant schizophrenia. Limitations and recommendations. Drug, 45, 374–383.Google Scholar
Fischer-Kornelsson, K. A. & Ferner, U. J. (1976) An example of European multicentre trials: multispectral analysis of clozapine. Psychopharmacology Bulletin, 12, 34–39.Google Scholar
Gerlach, J., Koppelhus, P., Helweg, E., et al (1974) Clozapine and haloperidol in a single blind crossover trial. Therapeutic and biochemical aspects in the treatment of schizophrenia. Acta Psychiatrica Scandinavica, 50, 410–424.Google Scholar
Herz, M. I., Glazer, W., Mirza, M., et al (1989) Treating prodromal episodes to prevent relapse in schizophrenia. British Journal of Psychiatry, 155, 123–127.CrossRefGoogle Scholar
Honigfeld, G. & Patin, J. (1990) A two year clinical and economic follow up of patients and clozapine. Hospital and Community Psychiatry, 41, 882–885,Google Scholar
Huckle, P. L. & Palia, S. S. (1993) Managing resistant schizophrenia. British Journal of Hospital Medicine, 50, 467–471.Google Scholar
Kane, J. M. (1992) Clinical efficacy of clozapine in treatment refractory schizophrenia: an overview. British Journal of Psychiatry, 160 (Suppl. 17), 41–45.Google Scholar
Kane, J. M., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment resistant schizophrenic: a double blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.Google Scholar
Kane, J. M., Honigfeld, G., Singer, J., et al (1990) Is clozapine response different in neuroleptic non-responders vs partial responders: in reply. Archives of General Psychiatry, 47, 189–190.Google Scholar
Kuehnel, T. C., Liberman, R. P., Marshall, B. D., et al (1992) Optimal drug and behaviour therapy for treatment-refractory, institutionalised schizophrenics. In Effective Psychiatric Rehabilitation: New Directions for Mental Illness Services (ed. Liberman, R.), pp. 67–77. San Francisco: Josey Bass.Google Scholar
Lader, M. (1994) Does Clozaril improve the cognitive and psychomotor function of schizophrenic patients? Clozaril Newsletter, 8, 1–3.Google Scholar
Levinson, D. F. (1991) Pharmacologic treatment of schizophrenia. Clinical Therapeutics, 13, 326–352.Google ScholarPubMed
Lindstrom, L. H. (1988) The effect of long term treatment with clozapine in schizophrenia: a retrospective study in 96 patients treated with clozapine for up to 13 years. Acta Psychiatrica Scandinavica, 77, 524–529.Google Scholar
Marder, S. R. & Van Putten, T. (1988) Who should receive clozapine? Archives of General Psychiatry, 45, 865–867.Google Scholar
Meltzer, H. Y. (1992) Treatment of the neuroleptic, non-responsive schizophrenic patient. Schizophrenic Bulletin, 18, 515–542.CrossRefGoogle Scholar
Meltzer, H. Y., Burnett, S., Bastina, B., et al (1990) Effects of 6 months of clozapine treatment on the quality of life in chronic schizophrenic patients. Hospital and Community Psychiatry, 41, 892–897.Google Scholar
Muijen, M. (1994) Rehabilitation and care of the mentally ill. Current Opinion in Psychiatry, 7, 202–206.Google Scholar
Muijen, M., Marks, I. M., Connolly, J., et al (1992) The Daily Living Programme: preliminary comparison of community versus hospital-based treatment for the seriously mentally ill facing emergency admission. British Journal of Psychiatry, 160, 379–384.Google Scholar
Osser, D. N. (1989) A systematic approach to pharmacotherapy in patients with neuroleptic resistant psychoses. Hospital and Community Psychiatry, 40, 921–927.Google Scholar
Peroutka, S. J. & Snyder, S. H. (1980) Relationship of neuroleptic drug effects on brain dopamine, serotonin, alpha-adrenergic and histamine receptors to clinical potency. American Journal of Psychiatry, 137, 1518–1519.Google ScholarPubMed
Pickar, D., Owen, R. R., Litman, R. E., et al (1992) Clinical and biologic response to clozapine in patients with schizophrenia. Archives of General Psychiatry, 49, 345–353.Google Scholar
Small, J., Kelloms, J. J., Milstein, V., et al (1975) A placebo-controlled study of lithium combined with neuroleptics in chronic schizophrenic patients. American Journal of Psychiatry, 132, 1315–1317.Google Scholar
Thompson, C. (1994) The use of high dose antipsychotic medication. British Journal of Psychiatry, 164, 448–458.Google Scholar
Van putten, T., Marshall, B. D., Liberman, R., et al (1993) Systematic dosage reduction in treatment resistant schizophrenic patients. Psychopharmacology Bulletin, 29, 315–320.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C. E. & Leff, J. P. (1981) Patterns of emotional response in relatives of schizophrenic patients. Schizophrenia Bulletin, 7, 43–44.Google Scholar
Witheridge, T. F. (1991) The “Active ingredients” of Assertive Outreach. In New Directions for Mental Health Services, pp. 47–64. Josey-Bass.Google Scholar
Wolkowitz, O. M., Turetsky, N., Reus, V. I., et al (1992) Benzodiazepine augmentation of neuroleptics in treatment resistant schizophrenia. Psychopharmacology Bulletin, 28, 291–295.Google Scholar
Zastowny, T. R., Lehman, A. F., Cole, R. E., et al (1992) Family management of schizophrenia: a comparison of behavioural and supportive family treatment. Psychiatric Quarterly, 63, 159–186.CrossRefGoogle ScholarPubMed
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