title: Schizophrenia: when clozapine fails.
abstract: OBJECTIVE
  This article reviews the recent evidence for therapeutic strategies for patients with treatment-resistant schizophrenia (TRS) not responding to or only partially responding to clozapine.
  
  
  RESULTS
  A number of pharmacological and nonpharmacological biological approaches for clozapine-resistant TRS have been evaluated in clinical trials. Among these, the evidence supporting clozapine augmentation by pharmacological approaches is weak and the reported benefits were modest at best. However, the results of a recent randomized trial suggest that electroconvulsive therapy (ECT) may be efficacious for the short-term treatment of patients with clozapine-resistant TRS.
  
  
  CONCLUSIONS
  There is currently insufficient evidence for efficacy of pharmacological augmentation strategies to clozapine. ECT may be a promising option, but further research is necessary to confirm its long-term effects. Moreover, further controlled studies are warranted to clarify the potential of other biological and psychosocial approaches to serve as adjuvant treatments in patients with clozapine-resistant TRS.
authors.affiliation: aDepartment of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan bNorth Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA cDepartment of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Seiya
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Lars Fredrik
authors.initials: LF
authors.lastname: Jarskog
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D006801:Humans; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine