AUGMENTING CLOZAPINE NON-RESPONSE IN SCHIZOPHRENIA WITH PSYCHOSOCIAL INTERVENTIONS: LESSONS FROM A PATIENT SERIES
VIJAYA LAKSHMI VALAPARLA
Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh 160012, India
VANDANA PATIDAR
Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh 160012, India
SUBHO CHAKRABARTI *
Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh 160012, India
*Author to whom correspondence should be addressed.
Abstract
Aims: About 40% to 70% of patients with treatment-resistant schizophrenia respond inadequately to clozapine. Augmentation with other medications or electroconvulsive therapy confers very little benefit in clozapine non-response. Research on augmentation with psychosocial treatments in clozapine-resistance is limited, but shows some promise. The benefits of psychosocial interventions in augmenting clozapine-response are highlighted by the treatment histories of three patients with treatment-resistant schizophrenia who responded poorly to clozapine.
Presentation of Cases: In these three patients with clozapine-resistance, combining cognitive-behavioral therapy (CBT) with family-psychoeducation, individual supportive treatment and stress-management yielded more enduring and a greater range of benefits, than could be achieved with augmentation by somatic treatments.
Discussion: The success achieved with these patients advocates the need for more randomized-controlled trials to examine the efficacy of psychosocial interventions in augmenting inadequate treatment-response among patients with clozapine-resistance.
Conclusion: Psychosocial interventions, which combine CBT with other treatment-modalities such as individual support, family-psychoeducation and stress-management, might be more useful in augmenting clozapine non-response.
Keywords: Clozapine, non-response, resistance, augmentation, psychosocial interventions