Clozapine combinations in treatment-resistant schizophrenia patients

Schizophrenia is a severe disabling mental illness affecting about 1% of the population throughout the world. Antipsychotic medications (conventional and atypical antipsychotics) are the pharmacological basis for the cure of schizophrenia and schizoaffective patients, however not all patients are positively affected by this treatment. One fifth to one third of people suffering from schizophrenia is considered as treatment resistant. In other words, these people have persistent psychotic symptoms and poor functioning despite adequate treatment with conventional or novel antipsychotics.To date one of the most effective medications is clozapine, which produces clinically significant improvement of symptoms in 30-50% of patients receiving it. However, from one-third to two thirds of schizophrenia patients still have persistent ‘positive’ symptoms despite adequate dosage and duration of clozapine monotherapy.Among treatment-resistant schizophrenia patients with poor response to an adequate trial of clozapine monotherapy, 30-50% are treated with a combination of clozapine and second psychotropic medication.Clinicians usually prescribe a combination of antipsychotics, in order to reach a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy.In this chapter, we present a summary of the literature concerning the combination of clozapine with different psychotropic medications or procedure in management of resistant schizophrenia and schizoaffective patients.