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When Clozapine Fails: Augmentation Strategies in the Management of Clozapine-Resistant Schizophrenia

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Treatment Resistance in Psychiatry

Abstract

Schizophrenia is a chronic and debilitating illness affecting about 0.5% of the population. Antipsychotics are the mainstay of the pharmacological treatment of such burdensome condition, although documented that roughly 20% up to 60% of the patients with schizophrenia do not respond sufficiently to conventional treatments. These patients may have a good response when clozapine is introduced with a great efficacy often seen in everyday clinical practice. However, it has been estimated that around 40–70% of patients with ascertained treatment-resistant schizophrenia receiving clozapine may have an incomplete remission and are referred to as “ultra-resistant” or “refractory.” Clozapine-resistant schizophrenia represents a challenge for the clinician and a misfortune for the patients, and several strategies have been proposed to overcome this problem, yet, to date, it remains high-bar goal. The aim of this chapter was to provide an overview of the managing strategies of clozapine-resistant schizophrenia with a particular focus on augmentation strategies aimed to improve efficacy on schizophrenia symptoms.

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Authors and Affiliations

  1. National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, Teramo, Italy

    Domenico De Berardis

  2. Department of Neuroscience, Imaging and Clinical Science, University “G. D’Annunzio”, Chieti, Italy

    Domenico De Berardis, Federica Vellante, Giovanni Martinotti & Massimo Di Giannantonio

  3. Polyedra Research Group, Teramo, Italy

    Michele Fornaro, Alessandro Valchera & Laura Orsolini

  4. Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine ‘Federico II’ Naples, Naples, Italy

    Michele Fornaro & Annalisa Anastasia

  5. Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy

    Alessandro Valchera

  6. Department of Theory, Analysis, Composition and Direction, Music Conservatory “L. Canepa”, Sassari, Italy

    Marilde Cavuto

  7. Department of Clinical Neurosciences, Hermanas Hospitalarias, FoRiPsi, Villa San Benedetto Menni, Como, Italy

    Giampaolo Perna

  8. Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands

    Giampaolo Perna

  9. Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Coral Gables, FL, USA

    Giampaolo Perna

  10. Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy

    Marco Di Nicola

  11. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy

    Gianluca Serafini

  12. NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “Madonna Del Soccorso”, San Benedetto del Tronto, Italy

    Alessandro Carano

  13. Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Maurizio Pompili

  14. Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield, Herts, UK

    Laura Orsolini & Giovanni Martinotti

  15. NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital of Giulianova, Teramo, Italy

    Carmine Tomasetti

  16. NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Mental Health Center of Giulianova, Teramo, Italy

    Gabriella Di Emidio

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  1. Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea (Republic of)

    Yong-Ku Kim

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De Berardis, D. et al. (2019). When Clozapine Fails: Augmentation Strategies in the Management of Clozapine-Resistant Schizophrenia. In: Kim, YK. (eds) Treatment Resistance in Psychiatry. Springer, Singapore. https://doi.org/10.1007/978-981-10-4358-1_23

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