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Treatments for medication-resistant schizophrenia

What is medication resistance? 

Antipsychotic medications provide symptom respite and improvement in quality of life for many people with schizophrenia. However, for a subset of people with schizophrenia, antipsychotic medications do not provide adequate relief from symptoms. Treatment-resistant schizophrenia has many definitions that vary depending on the individual study, but a broad definition includes those patients whose symptoms have not responded to antipsychotic medications, or only partially responded.

What is the evidence for medication resistance?

Moderate to high quality evidence suggests a general pattern of superiority for olanzapine, clozapine and risperidone over other antipsychotics (first or second generation) for symptom improvement in people with treatment-resistant schizophrenia. There may be fewer extrapyramidal side effects with clozapine or olanzapine than with other antipsychotics.

Augmenting clozapine with aripiprazole may provide some improvement in overall symptoms and may result in less weight gain and lower LDL-cholesterol than with placebo, but aripiprazole may result in more akathisia, agitation and anxiety. There are no significant improvements in symptoms after augmenting clozapine with lamotrigine, topiramate, glycine, risperidone, or sulpiride.

Also see the Course and Outcome topic on treatment resistance.


March 2017

Page last updated: 2:00  7 September 2017

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