Psychiatria pre prax 1/2010

Treatment of resistant schizophrenia in clinical practice

Treatment of resistant schizophrenia is a serious medical problem. Although it does not exist its common definition, its main criterium is failure of two treatment trials with antipsychotics from two different chemical classes in sufficient dosage and duration. The article deals with possibilities of pseudoresistance, especially false diagnosis, comorbidity, insufficient treatment trials and non-compliance. In the case of treatment-resistant schizophrenia we have several treatment strategies, which can be divided into pharmacological and nonpharmacological methods. The key position keeps clozapine, which efficacy was confirmed repeatedly. Another treatment possibilities consist of combination of antipsychotics, their augmentation and then nonpharmacological strategies, especially electroconvulsive therapy, experimentally used repetitive transcranial magnetic stimulation and also psychotherapy.

Keywords: treatment-resistant schizophrenia, clozapine, combination of antipsychotics, augmentation of antipsychotics, ECT, rTMS