The effects of duloxetine augmentation on clozapine in the treatment of negative symptoms in treatment resistant schizophrenia

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Ritvij M Satodiya
Keyword(s):  
Treatment Response ◽  
Satisfactory Result ◽  
Negative Symptoms ◽  
Life Quality ◽  
Direct Impact ◽  
Treatment Resistant ◽  
Clozapine Treatment ◽  
Response Current ◽  
Psychopharmacological Agents

The negative symptoms of schizophrenia have always been a challenge in treatment. The intensity and chronicity of these symptoms has direct impact on the life quality and treatment response. Current psychopharmacological agents have not offered a satisfactory result in addressing the negative symptoms of schizophrenia. The clinicians struggle with the approaches that can be utilized to target the negative symptoms of schizophrenia as no well-defined evidence exist. We present a case of treatment resistant schizophrenia with negative symptoms that responded well with augmentation of Duloxetine to Clozapine treatment.

Clozapine in treatment-resistant schizophrenic patients: preliminary results from an open prospective study

1996 ◽  
Vol 13 (1) ◽  
pp. 13-18
Author(s):  
Isabelle Jalenques ◽  
Eliane Albuisson ◽  
Igor Tauveron
Keyword(s):  
Prospective Study ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Health Care Utilisation ◽  
Positive Symptoms ◽  
Treatment Resistant ◽  
Beneficial Effects ◽  
Clozapine Treatment ◽  
Schizophrenic Patients ◽  
Open Prospective Study

AbstractObjective:This report describes an open prospective study of the effects of clozapine on positive and negative symptomatology in treatment resistant schizophrenic patients.Method:In this prospective study, 15 DSM-III-R schizophrenic patients, who had failed to respond to various neuroleptics were followed up for a period of 21 months (median: 9; 25th and 75th percentiles: 4-10). When clozapine treatment was initiated, the mean duration of the illness was 16 +/-9 years. Brief Psychiatric Rating Scale (BPRS) scores, BPRS ‘positive symptoms’ and BPRS ‘anergia factor’ scores were all rated at days 0 and 15, months one, two and three and every three months thereafter.Results:Significant improvements in total BPRS scores, BPRS positive symptoms and anergia factor were recorded and resulted in two distinct patterns of outcome. The improvements in BPRS scores translated into marked changes in health care utilisation and in sheltered employment. Of the side effects noted, dry mouth was more common in the first month after wash-out (three patients), while hypersalivation was more frequent after this period (eight patients). There was no agranulocytosis in this cohort. Two cases of eosinophilla occurred during the first month. Weight gain affected six patients.Conclusions:We found that clozapine offers particular benefits for some treatment-resistant schizophrenic patients despite the increased hematologic risk. Our study also indicates that the beneficial effects of clozapine are delayed in relation to negative symptoms as compared with positive symptoms.

Idazoxan and Response to Typical Neuroleptics in Treatment-Resistant Schizophrenia

1996 ◽  
Vol 168 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Robert E. Litman ◽  
Tung-Ping Su ◽  
William Z. Potter ◽  
Walter W. Hong ◽  
David Pickar
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Random Order ◽  
Symptom Improvement ◽  
Treatment Resistant ◽  
Neuroleptic Treatment ◽  
Double Blind ◽  
Clozapine Treatment ◽  
Psychiatric Rating Scale ◽  
Typical Neuroleptics

BackgroundWe investigated whether antagonism of α2adrenergic receptors would augment treatment response in schizophrenia, by administering idazoxan, an α2antagonist drug, to treatment-resistant patients on typical neuroleptics.MethodSeventeen hospitalised treatment-resistant patients with DSM–III–R schizophrenia or schizoaffective disorder were studied on typical neuroleptic treatment, on treatment with idazoxan plus typical neuroleptic, and after discontinuation of idazoxan, in fixed, non-random order, and under double-blind, placebo-controlled conditions.ResultsThe addition of idazoxan to fluphenazine treatment resulted in significant reductions of global psychosis and total, positive and negative symptoms on the Brief Psychiatric Rating Scale, compared to neuroleptic treatment alone. Symptom improvement significantly correlated with idazoxan-induced changes in indices of noradrenergic function. In a subgroup of patients, idazoxan plus typical neuroleptic treatment compared favourably with clozapine treatment, when both were compared to typical neuroleptic treatment alone.ConclusionsThe antagonism of α2receptors augmented therapeutic response to typical neuroleptic treatment in treatment-resistant patients with schizophrenia. This antagonism may contribute to clozapine's superior antipsychotic effects.

Treatment Resistance: A Time-Based Approach For Early Identification in First Episode Samples

2018 ◽  
Author(s):  
Kara Dempster ◽  
Ross Norman ◽  
Lena Palaniyappan
Keyword(s):  
Early Intervention ◽  
Treatment Response ◽  
Intervention Program ◽  
Negative Symptoms ◽  
Treatment Resistance ◽  
First Episode ◽  
Symptom Improvement ◽  
Treatment Resistant ◽  
Early Intervention Program ◽  
First Episode Schizophrenia

Background: Although approximately 1/3 of individuals with schizophrenia are Treatment Resistant (TR), identifying these subjects prospectively for early intervention remains challenging. The Treatment Response and Resistance in Psychosis (TRIPP; Howes et al, 2017) working group recently published consensus guidelines defining lack of response as a <20% improvement in symptoms. However, it is unclear whether these criteria are sensitive in First Episode Schizophrenia (FES). Method: Patients experiencing a first episode of psychosis referred to the Prevention and Early Intervention Program for Psychosis (PEPP) in London, Canada were followed-up with longitudinal symptom assessments. We evaluated two improvement thresholds for ‘probable TR’ classifications; <20% (as per TRIPP) and <50% to identify subjects satisfying ‘probable TR’ based on positive, negative, and total symptom domains.Results: Using the criterion of <50% total, or <20% negative symptom improvement,resulted in ‘probable TR’ rates of 37% and 33% respectively, with notable overlap between the 2criteria (77% satisfying both). Using a 20% cut-off for positive and total symptomsresulted in very low rates of ‘probable TR’. Logistic regression analyses demonstrated that poorpremorbid functioning, longer duration of untreated illness, and limited treatment response atmonths one and two were significantly associated with probable TR (<50% totalsymptom improvement).Conclusions: Our results suggest that probable TR may be identified at 6 months after FESusing a time-based approach only by including negative symptoms (either alone, with a 20%improvement threshold, or in addition to positive symptoms, with a total 50%threshold) in the definition.

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

scholarly journals An evaluation of barriers to the initiation of clozapine in patients with treatment-resistant schizophrenia

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S30-S31
Author(s):  
Declan Hyland ◽  
Seth Jamieson
Keyword(s):  
Systematic Review ◽  
Significant Progress ◽  
Treatment Resistant ◽  
The South ◽  
Online Questionnaire ◽  
Blood Testing ◽  
Likert Scales ◽  
Clozapine Treatment ◽  
Patient Barriers ◽  
Made In

AimsThis evaluation aimed to identify patient, practitioner and infrastructural barriers to initiation of clozapine treatment in patients with treatment-resistant schizophrenia (TRS). In response to recent research supporting use of clozapine as the most effective treatment for patients with TRS, concerted efforts have been made to establish why clozapine is underutilised in the NHS. Following a study conducted by South London and Maudsley NHS Foundation Trust, which identified barriers and made recommendations, this evaluation aimed to identify barriers to initiation of clozapine in patients under the care of Mersey Care NHS Foundation Trust.This evaluation also aimed to make further recommendations to increase use of clozapine in Mersey Care's TRS patients and assess whether there have been any differences to concerns about clozapine initiation compared to previous evaluations.MethodAn online questionnaire containing a series of Likert scales was e-mailed to all Consultant Psychiatrists in Mersey Care NHS Foundation Trust. The questionnaire asked Consultants to rate how often they felt a range of barriers interfered with successful initiation of Clozapine treatment. The barriers chosen were based on the 2019 systematic review “Barriers to using clozapine in treatment-resistant schizophrenia.”ResultNineteen consultant psychiatrists completed the online questionnaire. All 19 indicated they either “agreed” (16%) or “strongly agreed” (84%) that they were confident in diagnosing TRS. This was a significant increase compared to the South London and Maudsley evaluation, with only 81% of participants in that study being “fairly familar” or “very familiar” with clozapine guidelines.Furthermore, concerns about inadequate blood testing facilities appear to have been addressed, with no participants in this evaluation staing there were insufficient blood testing facilities. However, 53% of Consultants who completed this evaluation stated they “often” (37%) or “very often” (16%) have patients who refuse clozapine because of the requirement for regular blood testing. Refusal to agree to required blood testing was the commonest reason identified for failure to initiate clozapine in TRS patients. This was consistent with the results from the South London and Maudsley study.ConclusionThose Mersey Care consultants surveyed identified that providing patients with further information about clozapine would be the most valuable intervention to increase likelihood of uptake of clozapine in the treatment of TRS. Significant progress has been made in improving the likelihood that clozapine can be successfully initiated, especially in the removal of practitioner barriers. This evaluation suggests interventions should now be aimed at reducing patient barriers to initiation of treatment.

Baseline Working Memory Predicted Response to Low-Dose Ketamine Infusion in Patients with Treatment-Resistant Depression

2021 ◽  
Author(s):  
Mu-Hong Chen ◽  
Wei-Chen Lin ◽  
Cheng-Ta Li ◽  
Shih-Jen Tsai ◽  
Hui-Ju Wu ◽  
...  
Keyword(s):  
Working Memory ◽  
Depressive Symptoms ◽  
Treatment Response ◽  
Low Dose ◽  
Memory Function ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Treatment Groups ◽  
Resistant Depression

Abstract Introduction Pretreatment neurocognitive function may predict the treatment response to low-dose ketamine infusion in patients with treatment-resistant depression (TRD). However, the association between working memory function at baseline and the antidepressant efficacy of ketamine infusion remains unclear. Methods A total of 71 patients with TRD were randomized to one of three treatment groups: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, or normal saline. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HDRS) at baseline and after treatment. Cognitive function was evaluated using working memory and go-no-go tasks at baseline. Results A generalized linear model with adjustments for demographic characteristics, treatment groups, and total HDRS scores at baseline revealed only a significant effect of working memory function (correct responses and omissions) on the changes in depressive symptoms measured by HDRS at baseline (F=12.862, p<0.05). Correlation analysis further showed a negative relationship (r=0.519, p=0.027) between pretreatment working memory function and changes in HDRS scores in the 0.5 mg/kg ketamine group. Discussion An inverse relationship between pretreatment working memory function and treatment response to ketamine infusion may confirm that low-dose ketamine infusion is beneficial and should be reserved for patients with TRD.

Clozapine: A Case Vignette

1996 ◽  
Vol 4 (6) ◽  
pp. 336-337
Author(s):  
Ilana Nayman
Keyword(s):  
Young Woman ◽  
Psychiatric Practice ◽  
Case Vignette ◽  
Treatment Resistant ◽  
Symptom Resolution ◽  
Clozapine Treatment ◽  
Level Of Functioning ◽  
History Of ◽  
High Level

This paper describes successful clozapine treatment in a young woman with a five year history of treatment-resistant schizophrenia. After various treatment-resistant strategies had been given, clozapine was commenced. Symptom resolution within 4 months and sustained high level of functioning within 7 months was achieved. The role of clozapine in general psychiatric practice is evident. Clozapine should be considered earlier in the illness course than was formerly the case.

scholarly journals Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology

2017 ◽  
Vol 174 (3) ◽  
pp. 216-229 ◽  
Author(s):  
Oliver D. Howes ◽  
Rob McCutcheon ◽  
Ofer Agid ◽  
Andrea de Bartolomeis ◽  
Nico J.M. van Beveren ◽  
...  
Keyword(s):  
Treatment Response ◽  
Working Group ◽  
Group Consensus ◽  
Consensus Guidelines ◽  
Treatment Resistant

scholarly journals Successful rechallenge with paliperidone after clozapine treatment for a patient with dopamine supersensitivity psychosis

2020 ◽  
Vol 8 ◽  
pp. 2050313X2092956
Author(s):  
Remiko Kobayashi ◽  
Yasunori Oda ◽  
Ryunosuke Hayatsu ◽  
Nozomi Ohki ◽  
Misa Akutsu ◽  
...  
Keyword(s):  
Symptomatic Relief ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Clozapine Treatment ◽  
Clozapine Dose ◽  
Japanese Male ◽  
Old Japanese ◽  
Dopamine Supersensitivity

We describe the case of a 49-year-old Japanese male patient successfully treated with a paliperidone rechallenge following 2-year treatment with clozapine for treatment-resistant schizophrenia. He had responded well to conventional antipsychotic treatment for the initial psychotic episode but gradually developed dopamine supersensitivity; even treatment with paliperidone and another antipsychotic medication (a total up to 1700 mg in chlorpromazine-equivalent dose) had not improved his psychotic symptoms. Clozapine treatment produced temporary symptomatic relief, but the clozapine dose could not be increased to > 150 mg due to the patient’s intolerance. Following low-dose clozapine treatment for 2 years, a rechallenge with paliperidone monotherapy ameliorated his psychotic symptoms. This suggests that clozapine may have the potential to release the dopamine supersensitivity state. Our patient’s case indicates that for patients with dopamine supersensitivity psychosis, a rechallenge with a previously ineffective antipsychotic after clozapine treatment may be successful.

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