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    Pharmacological Options FOR Treatment-Resistant Schizophrenia (TRS)

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    selimbabu93
    The document discusses pharmacological treatment options for treatment-resistant schizophrenia, including clozapine monotherapy and augmentation as the treatment of choice. It outlines definitions, alternatives to clozapine such as high-dose antipsychotic monotherapy or polypharmacy and adjunct treatments. Guidelines for clozapine treatment and augmentation options are provided.

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    Pharmacological Options FOR Treatment-Resistant Schizophrenia (TRS)

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    selimbabu93
    11 views15 pages
    The document discusses pharmacological treatment options for treatment-resistant schizophrenia, including clozapine monotherapy and augmentation as the treatment of choice. It outlines definitions, alternatives to clozapine such as high-dose antipsychotic monotherapy or polypharmacy and adjunct treatments. Guidelines for clozapine treatment and augmentation options are provided.

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    Pharmacological treatment of treatment resistant schizophrenia

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    TRS

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    The document discusses pharmacological treatment options for treatment-resistant schizophrenia, including clozapine monotherapy and augmentation as the treatment of choice. It outlines definitions, alternatives to clozapine such as high-dose antipsychotic monotherapy or polypharmacy and adjunct treatments. Guidelines for clozapine treatment and augmentation options are provided.

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    11 views15 pages

    Pharmacological Options FOR Treatment-Resistant Schizophrenia (TRS)

    Uploaded by

    selimbabu93
    The document discusses pharmacological treatment options for treatment-resistant schizophrenia, including clozapine monotherapy and augmentation as the treatment of choice. It outlines definitions, alternatives to clozapine such as high-dose antipsychotic monotherapy or polypharmacy and adjunct treatments. Guidelines for clozapine treatment and augmentation options are provided.

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    You are on page 1of 15

    PHARMACOLOGICAL OPTIONS

    FOR
    TREATMENT-RESISTANT
    SCHIZOPHRENIA(TRS)

    DR.MD.SELIM BABU
    PHASE-B RESIDENT
    DEPARTMENT OF PSYCHIATRY
    BSMMU
    DEFINITION

    • Treatment-resistant schizophrenia defined as a failure to respond to two trial


    of anti-psychotic medications,one being second generation,of adeqauet dose
    and duration.
    TREATMENT OPTIONS FOR TRS

    • Clozapine
    Clozapine monotherapy
    Augmentation of Clozapine
    • Aternatives to clozapine
    ATERNATIVES TO CLOZAPINE
    • Non-clozapine antipsychotics monotherapy in high doses
    • Non-clozapine antipsychotics polypharmacy
    • Adjuncts to antipsychotics
    Anti-inflammatory agents
    NMDA receptor modulators
    Antidepressants
    Antiseizure medications
    • Physical treatments
    • Psychological therapies
    SUMMARY OF CLOZAPINE TREATMENT
    • The choice of treatment for people with TRS
    • Response rate 30-75%
    • Can be initiated within 6-12 months of treatment resistance.
    • Response usually seen in the range 150–900mg/day
    • Plasma levels range 350–420μg/l.
    • A plasma level of 350μg/l should be aimed to ensure an adequate trial, but
    response may occur at lower plasma level.
    SUMMARY OF CLOZAPINE TREATMENT

    • Started at a dose of 12.5mg at night


    • On day 2, dose can be increased to 12.5mg twice daily.
    • Then dose can be increased by 25–50mg/day, until a dose of 300mg a day is
    achieved in 2–3 weeks.
    • Further dosage increases slowly 50–100mg /week.
    SUMMARY OF CLOZAPINE TREATMENT

    • The total clozapine dose should be divided (usually twice daily)


    • Dose gradually tapered over 1-2 weeks.
    • If therapy is interrupted for >48 hrs, must be started at
    12.5-25 mg /day
    • Should be continue for at least 6 months for an adequate trial.
    • Initial laboratory work-up,dose titration,monitoring of blood and
    screening for other side effects must be ensured.
    AUGMENTATION OF CLOZAPINE

    • Should be considered after at least 3 months of optimized clozapine


    momotherapy.
    • An agent should be chosen considerning its complementay receptor profile
    to clozapine and resultant burden of side-effects.
    OPTIONS FOR AUGMENTING CLOZAPINE
    • Amisulpride (400–800mg/day)
    • Aripiprazole (15–30mg/day)
    • Haloperidol (2–3mg/day)
    • Risperidone (2–6mg/day)
    • Sulpiride (400mg/day)
    • Topiramate (50–300mg/day)
    • Sodium valproate (400–800mg/day)
    • Lamotrigine (25–300mg/day)
    • Omega-3 triglycerides (2–3g EPA daily)
    ATERNATIVES TO CLOZAPINE
    ATERNATIVES TO CLOZAPINE
    ATERNATIVES TO CLOZAPINE
    REFERENCE

    • The Maudsley Prescribing Guidelines in Psychiatry


    • BAP Guidelines for Management of Schizophrenia
    Thank You

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