Mens Sana Monographs
REVIEW ARTICLE
Year
: 2012  |  Volume : 10  |  Issue : 1  |  Page : 20--32

Treatment-resistant schizophrenia: Evidence-based strategies


Susanne Englisch1, Mathias Zink2 
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

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.


How to cite this article:
Englisch S, Zink M. Treatment-resistant schizophrenia: Evidence-based strategies.Mens Sana Monogr 2012;10:20-32


How to cite this URL:
Englisch S, Zink M. Treatment-resistant schizophrenia: Evidence-based strategies. Mens Sana Monogr [serial online] 2012 [cited 2019 Oct 21 ];10:20-32
Available from: http://www.msmonographs.org/article.asp?issn=0973-1229;year=2012;volume=10;issue=1;spage=20;epage=32;aulast=Englisch;type=0