Psychiatria pre prax 1/2015

Treatment of hospitalized patients with schizophrenia

The most frequent reasons for hospitalization in patients suffering from schizophrenia are relapses and pharmacoresistancy. The main cause of relapse is nonadherence which can be partially managed by depot antipsychotics. The gold standard of treatment in pharmacoresistant patients is clozapine. In spite of this clozapine is initiated late in clinical practice and before initiating clozapine, antipsychotic polypharmacy is very common. After the failure of clozapine monotherapy there are several possibilities including combination of clozapine with other antipsychotics and clozapine augmentation. There are very few controlled studies supporting these strategies with inconsistent results; therefore the pseudoresistance should be eliminated. The optimal possibility includes clozapine plasma levels assessment. The results obtained at department of psychiatry in Brno show, that in patients non-responding to clozapine its plasma levels are surprisingly often out of the therapeutic range. The clozapine plasma levels assessment in these problematic patients helps to choose the further optimal treatment strategy.

Keywords: schizophrenia, relaps, pharmacoresistance, combinatins of antipsychotics, clozapine, plasma levels.