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Treatment-Resistant Schizophrenia & Clozapine

Schizophrenia that is resistant to treatment is a major clinical challenge. Almost 30 percent of people living with schizophrenia find their illness to be treatment-resistant, meaning that antipsychotic treatments have not been effective.

Guidelines for low-income individuals with treatment-resistant schizophrenia

Many national organizations provide clinical practice guidelines for physicians and health care providers to help ensure people with schizophrenia receive consistently high-quality care. The Canadian Schizophrenia Guideline Panel has developed the guideline for schizophrenia assessment, diagnosis and pharmacological treatment, updating the 2005 guidelines for Canadian health care professionals. 

BC Mental Health and Substance Use Services Research Institute’s Dr. William Honer, as part of an international working group called Treatment Response and Resistance in Psychosis (TRRIP), has helped create the first consensus guidelines on assessing treatment-resistance in order to improve schizophrenia interventions, with a focus on clozapine. 

Dr. Honer works with people in low-income Vancouver neighbourhoods who are experiencing schizophrenia, trying to understand how it affects their lives. This knowledge can help optimize treatment plans for clients and help other health care practitioners better to address their needs.

People diagnosed with schizophrenia  may experience the following:

  • Dellusions
  • Hallucinations
  • Disordered thinking
  • Abnormal motor behaviour 
  • Substance use disorder
  • Medical conditions

Clozapine usage

Clozapine is often prescribed for patients who haven’t responded well to other types of antipsychotics. Over the years, the number of people whose schizophrenia has responded well to the medication has decreased. 

Part of the challenge in prescribing clozapine for people who experience treatment-resistant schizophrenia is decreasing the risk of and managing side effects. 

Researchers are now seeking ways to optimize treatment with clozapine and augment or suggest alternatives for clients for whom clozapine has been less than effective. 

COVID-19 and clozapine

In the context of the COVID-19 pandemic, a subgroup of the TRRIP working group has created a consensus statement on managing clozapine to support health care providers to continue to prescribe it as part of their patients’ treatment along with other non-medication supports. 

Dr. Honer’s recent research work focused on developing a set of international recommendations for using clozapine during the pandemic. There are complex issues in how COVID-19 affects the body and immune system that overlap with being able to use the medication safely. These are complicated issues that need special attention. 

Our researchers are researching ways to ensure that clients and patients with schizophrenia have access to vaccines and a safe way to continue their medications. 

SOURCE: Treatment-Resistant Schizophrenia & Clozapine ( )
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