• 대한조현병학회지
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• 제24권1호
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• pp.1-7
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• 2021

Clozapine is the first and most effective atypical antipsychotic drug for treatment-resistant schizophrenia (TRS). After withdrawal of clozapine due to concerns of agranulocytosis, clozapine was reintroduced with a comprehensive safety monitoring system, the clozapine patient monitoring system (CPMS). The reintroduction was a response to the pressure from psychiatrists and patients with TRS and their families. Clozapine is still the best single agent for the treatment of TRS. However, approximately 30% of patients with TRS still show psychotic symptoms. In patients with clozapine-resistant schizophrenia (CRS), augmentation of other antipsychotic agents could be considered after a thorough evaluation of proper clozapine treatment. In this review, the status of clozapine in patients with TRS and CRS will be discussed.

• 대한조현병학회지
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• 제23권2호
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• pp.45-50
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• 2020

Schizophrenia is one of serious mental illnesses and is often described as a heterogeneous disorder. Approximately one-third of schizophrenia cases are treatment-resistant schizophrenia (TRS). The aim of this study was to review the definitions and clinical features of TRS. Though it was found that the criteria for TRS were considerably diverse, the Treatment Response and Resistance in Psychosis (TRRIP) consensus criteria were recently introduced. According to the TRRIP criteria, TRS should be suspected if symptoms persist alongside psychotic symptoms despite sufficient treatment for ≥12 weeks, or two or more symptoms persist significantly for ≥6 weeks. The clinical characteristics of TRS includes an earlier age of onset, more severe and familial form, possibly more rural residence, unlikely association with male sex, and an increase in cognitive deficits.

• 신경정신의학
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• 제57권3호
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• pp.230-234
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• 2018

A large proportion of patients with schizophrenia show a poor response to first-line antipsychotic drugs, which is termed treatment-resistant schizophrenia. Previous studies found that a different neurobiology might underlie treatment-resistant schizophrenia, which necessitates the development of different therapeutic approaches for treating treatment-resistant schizophrenia. This study reviewed previous studies on the pathophysiology of treatment-resistant schizophrenia and the pharmacological intervention, and forthcoming investigations of treatment-resistant schizophrenia are suggested.

• 대한조현병학회지
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• 제24권2호
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• pp.52-59
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• 2021

Objectives: Recent studies have reported that delayed initiation of clozapine can affect clinical response in patients with treatment-resistant schizophrenia (TRS). This study aimed to explore the relationship between delayed initiation of clozapine and acute treatment response. Methods: Sixty-five inpatients with TRS who started clozapine for the first time were included through a retrospective chart review. Acute treatment response was defined as a 30% reduction in the Positive and Negative Syndrome Scale score or a Clinical Global Impression of Improvement score of 1 (very much improved) or 2 (much improved) at 4 weeks after initiating clozapine. Results: After meeting the TRS criteria, the mean delay for initiating clozapine was approximately 13.8 months. The delay was shorter in patients who showed a better response to clozapine in logistic regression analysis (p=0.037). Conclusion: Our findings suggest that reducing the delay in initiating clozapine increases the effectiveness of clozapine in patients with TRS.

• 대한조현병학회지
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• 제23권2호
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• pp.51-57
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• 2020

Treatment-resistant schizophrenia (TRS) has been defined as the persistence of positive symptoms despite two or more trials of antipsychotic medication of adequate dose and duration. TRS is a serious clinical problem and occurs in approximately 30% of patients with schizophrenia. It is important that patients who do not adequately respond to antipsychotics be reevaluated to exclude or address causes other than non-responsiveness to medication, that is, the possibility of pseudo-resistance. In particular, non-adherence to oral antipsychotic treatment should be monitored to rule out pseudo-resistant cases of TRS. Moreover, patients with TRS who take their medication as required may have subtherapeutic antipsychotic plasma levels, secondary to pharmacokinetic factors. In this paper, we review the concept and exclusion of pseudo-resistance, especially owing to non-adherence or pharmacokinetic factors, and present methods to enhance drug adherence.

• 정신신체의학
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• 제30권2호
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• pp.66-72
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• 2022

클로자핀은 치료 저항성 조현병 약물치료의 "최적 표준(gold standard)"으로 받아들여지고 있다. 클로자핀은 다른 항정신병약물에서 흔히 나타나는 추체외로 증후군, 지연이상 운동증을 거의 일으키지 않고 고프로락틴의 일시적인 상승만 보이는 한편, 발열 등의 약물 이상반응이 흔하게 나타난다. 치료 시작 시기에 드물게 무과립구증, 신경이완제 악성증후군과 같은 치명적인 부작용과 연관된 발열이 발생할 수 있으며, 이 경우 클로자핀을 즉시 중단해야 한다. 그러나 발열의 양성 원인은 생명을 위협하는 부작용보다 훨씬 빈번하므로 치료 시작 시기에 발열을 보이는 경우 무조건 클로자핀을 중단하는 것은 타당하지 않다. 또한, 치료 유지 시기에도 언제든지 발열은 발생할 수 있다. 특히 폐렴의 위험은 시간이 지남에 따라 감소하지 않으며, 클로자핀은 다른 항정신병약물 보다 폐렴의 위험이 높으므로 항상 이를 염두에 두고 치료제 모니터링을 통하여 약물 용량을 결정하는것이 권장된다.