TY - JOUR
T1 - When symptoms persist
T2 - Clozapine augmentation strategies
AU - Buckley, Peter F
AU - Miller, Alexander
AU - Olsen, Jerry
AU - Garver, David
AU - Miller, Del D.
AU - Csernansky, John
PY - 2001
Y1 - 2001
N2 - Recent data and clinical experience confirm that, in spite of superior efficacy for treatment-refractory schizophrenia, a substantial proportion of patients receiving clozapine will continue to experience disabling symptoms. Optimizing clozapine monotherapy is the first step in the management of "clozapine non-responders." Described here is a synthesis of the available literature on the range and efficacy of clozapine augmentation strategies that may be used when monotherapy fails. Treatment options include adjunctive antipsychotic medications, mood stabilizers, selective serotonin reuptake inhibitors, glycinergic agents, and electroconvulsive therapy. The evidence favoring one augmentation strategy over another is lacking; overall, adjunctive therapy is associated with only modest clinical improvement. Moreover, case series and open-labeled clinical trials dominate the extant literature, and there is a dearth of double-blind trials comparing these augmentation agents. Current systematic efforts to enhance the treatment of these patients with adjunctive therapies are worthy of being studied in carefully conducted clinical trials.
AB - Recent data and clinical experience confirm that, in spite of superior efficacy for treatment-refractory schizophrenia, a substantial proportion of patients receiving clozapine will continue to experience disabling symptoms. Optimizing clozapine monotherapy is the first step in the management of "clozapine non-responders." Described here is a synthesis of the available literature on the range and efficacy of clozapine augmentation strategies that may be used when monotherapy fails. Treatment options include adjunctive antipsychotic medications, mood stabilizers, selective serotonin reuptake inhibitors, glycinergic agents, and electroconvulsive therapy. The evidence favoring one augmentation strategy over another is lacking; overall, adjunctive therapy is associated with only modest clinical improvement. Moreover, case series and open-labeled clinical trials dominate the extant literature, and there is a dearth of double-blind trials comparing these augmentation agents. Current systematic efforts to enhance the treatment of these patients with adjunctive therapies are worthy of being studied in carefully conducted clinical trials.
KW - Antipsychotic response
KW - Augmentation
KW - Clozapine
KW - Schizophrenia
KW - Treatment refractory
UR - http://www.scopus.com/inward/record.url?scp=0035697271&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035697271&partnerID=8YFLogxK
U2 - 10.1093/oxfordjournals.schbul.a006901
DO - 10.1093/oxfordjournals.schbul.a006901
M3 - Article
C2 - 11824488
AN - SCOPUS:0035697271
SN - 0586-7614
VL - 27
SP - 615
EP - 628
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
IS - 4
ER -