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A Monograph Series Devoted To The Understanding Of Medicine, Mental Health, Man, Mind, Music And Their Matrix
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Year : 2012  |  Volume : 10  |  Issue : 1  |  Page : 20-32

Treatment-resistant schizophrenia: Evidence-based strategies


1 M.D. Senior Resident, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH). Mannheim, Germany
2 M.D. Psychiatrist, Senior Physician and Research Group Leader, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Mannheim, Germany

Correspondence Address:
Mathias Zink
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, P.O.Box: 12 21 20, D-68072 Mannheim
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1229.91588

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Treatment-resistant symptoms complicate the clinical course of schizophrenia, and a large proportion of patients do not reach functional recovery. In consequence, polypharmacy is frequently used in treatment-refractory cases, addressing psychotic positive, negative and cognitive symptoms, treatment-emergent side effects caused by antipsychotics and comorbid depressive or obsessive-compulsive symptoms. To a large extent, such strategies are not covered by pharmacological guidelines which strongly suggest antipsychotic monotherapy. Add-on strategies comprise combinations of several antipsychotic agents and augmentations with mood stabilizers; moreover, antidepressants and experimental substances are applied. Based on the accumulated evidence of clinical trials and meta-analyses, combinations of clozapine with certain second-generation antipsychotic agents and the augmentation of antipsychotics with antidepressants seem recommendable, while the augmentation with mood stabilizers cannot be considered superior to placebo. Forthcoming investigations will have to focus on innovative pharmacological agents, the clinical spectrum of cognitive deficits and the implementation of cognitive behavioral therapy.


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