Conference paper

TREATMENT-RESISTANT SCHIZOPHRENIA: CHALLENGES AND IMPLICATIONS FOR CLINICAL PRACTICE

Marina Šagud orcid.org/0000-0001-9620-2181 ; University Hospital Centre Zagreb, Department of Psychiatry, School of Medicine, University of Zagreb, Zagreb, Croatia

Abstract

Despite pharmacological advances in the treatment of schizophrenia, significant number of patients continue to be treatmentresistant.
Poor control of symptoms could be related to low concentration of antipsychotics because of non-adherence or
pharmacokinetic issues. However, there is growing evidence that “true” treatment-resistance might be associated with biological
changes, i.e. alterations in dopaminergic and glutaminergic systems, genetics, neurodegeneration and neuroinflamation.
Clozapine is recommended as first-line treatment for treatment-resistant schizophrenia (TRS) in all guidelines. Clozapine-ECT
combination is effective in majority of those patients, at least in short-term. However, more than half of patients with TRS have
resistance or intolerance to clozapine, and more interventions are needed. Different combination and augmentation strategies may
offer some advantage, but evidence is limited. Given the severity and complexity of TRS, there is an urgent need for better treatment.
Treatment strategies beyond dopamine, such as glutamate-modelling agents, nonsteroidal anti-inflammatory drugs (NSAIDs) and
hormonal treatment, are under investigation.

Keywords

treatment-resistant schizophrenia (TRS) – antipsychotics - clozapine

Hrčak ID:

162492

URI

https://hrcak.srce.hr/162492

Publication date:

23.9.2015.

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