Schizophrenia is a serious, persistent mental illness that affects about 1% of the population. While the majority of patients respond to antipsychotics, a proportion of patients will not respond to the suite of antipsychotics usually offered. After failing two trials of antipsychotics with adequate dose, duration and adherence, these patients are defined as “treatment-resistant”. Clozapine has been shown to be the gold standard as therapy for treatment-resistant schizophrenia and is essentially first-line treatment for patients with treatment-resistant schizophrenia. It is associated with a number of side effects, some of which can be severe or even fatal; therefore, close monitoring is required with clozapine therapy. In order to receive each clozapine dose, patients are required undergo weekly hematological monitoring to identify potential agranulocytosis, although frequency may be decreased to once every four weeks after a year without problems.
Patients gain the most benefit if treatment-resistant schizophrenia is identified as soon as possible and clozapine therapy started without delay.
This Self-Learning program has been certified by the College of Family Physicians of Canada for up to 1 Mainpro+ Credit. Cert+ Program ID#: 190271
|Ofer Agid, MD|
John Axler, MD, CCFP, FCFP
Christine Palmay, HBArt Sci., MD, CCFP
Glenn Pearce, MD, CCFP
After completion of the program, participants will be able to:
- Describe defining criteria for treatment-resistant schizophrenia
- Define an “adequate trial” with first- or second-line antipsychotics to determine whether the patient has responded or is resistant
- Explain the recommended treatment for patients with treatment-resistant schizophrenia
- Describe approaches to monitoring and addressing adverse effects associated with clozapine therapy