Management of patients with Clozapine Resistant Schizophrenia

BACKGROUND -: About 20-30% of patients with schizophrenia have treatment resistant schizophrenia (TRS). Clozapine is the only FDA approved drug to be used in patients with TRS. However, only 40-70% people with TRS show clinical response on clozapine, the rest being termed as Clozapine resistant schizophrenia. AIM -: To study the rate of patients with treatment resistant and clozapine resistant schizophrenia . To study the various augmentation strategies used in patient with clozapine resistant schizophrenia METHODOLOGY -: It was a retrospective case file based study conducted in a tertiary mental healthcare facility. Male patients admitted during a 2 year period from September 2019-2021 with diagnosis of schizophrenia were included in the study. The hospital record register was used to screen the case files of these patients. Among them, those who met the criteria of treatment resistance according to the Modified Kane’s criteria were further evaluated. Out of these patients, those who did not show any significant improvement on clozapine were considered to be Clozapine resistant schizophrenia. Various augmentation strategies used was studied. RESULTS-: 212 patients were admitted with diagnosis of schizophrenia. 19.8% (42) of them fulfilled the criteria for TRS and were given clozapine in varying doses . Among them, 19% (8) had clozapine resistant schizophrenia and four were given long acting injectables (Haloperidol Decanoate, Zuclopenthixol Decanoate) while the other four were given oral antipsychotics (Amisulpride, Trifluoperazine and Aripiprazole) along with Clozapine. CONCLUSION-: Clozapine is a proven strategy in TRS . However, a significant proportion does not respond to clozapine as well. Among the various available strategies, augmentation with other antipsychotics (both oral and long acting) is an effective option.