Treatment – refractory and super refractory schizophrenia – a case study
DOI:
https://doi.org/10.1515/cpp-2017-0022Keywords:
schizophrenia, clozapine, treatment refractorinessAbstract
Refractoriness affects about 25% of patients treated with antipsychotics, and it is a very big challenge for clinicians. The most commonly accepted definition of refractoriness is: lack of satisfactory clinical response to treatment with at least two antipsychotic drugs, from different groups, carried out at therapeutic doses and for a sufficiently long period.
Aim: The aim of the study is to analyze the case of a patient diagnosed with schizophrenia.
Methods: Analysis of medical records, available literature from recent years on treatment-refractory and super-refractory schizophrenia.
Results: A 53-year-old patient, a bachelor, suffering from paranoid schizophrenia with an extremely severe, non-remission course with drug resistance features. The patient's father and sister also suffer from severe paranoid schizophrenia. The patient became ill at the age of 22. Despite the high doses of clozapine, in a sufficiently long period of time, the patient maintained positive and negative symptoms, cognitive deficits and behavioral disorders.The patient was 14 times psychiatrically hospitalized, twice treated with electro-convulsive therapy, which did not bring results despite the combination of electroconvulsive therapywith psycho pharmacotherapy. In addition, the patient was addicted to benzodiazepines, administered during anxiety and anxiety attacks by the mother, during the described hospitalization, gradually discontinued. Patient after several attempts of committing suicide, with a tendency to self-destructive behavior. The illustrated case meets the criteria of super-refractory schizophrenia (SRS).
Conclusions:
- The category of refractory schizophrenia encountered in the literature is not a separate diagnostic category - it does not exist in classification systems, therefore we consider the phenomenon / symptom of drug resistance - variously defined.
- Social relations have a big impact on the functioning of the patient as well as the course of the disease and prognosis (the role of the family).
- There are numerous methods for the potentiating of clozapine treatment, of which combining clozapine with EC therapy is effective and safe. The strategy for combining clozapine with EC is effective, but not in all patients.
References
1. Jarema M. Leksykon schizofrenii. Poznań; Termedia 2010.
2. Brykalski J., Rajewska-Rager A., Sprawozdanie z IV Szkoły Neuropsychofarmakologii (ECNP), Oxford 2012.
3. Weiden P. J. How many treatments before clozapine? medication-choices across the spectrum of treatment resistance in schizophrenia. The Journal of Clinical Psychiatry, 2016, 77(5), e594.
4. Jarema M. Standardy leczenia farmakologicznego niektórych zaburzeń psychicznych, wyd. II, Gdańsk; Via Medica 2015.
5. Jaracz J. Dodanie leku przeciwpsychotycznego II generacji lub leku przeciwpadaczkowego jako metoda postępowania u chorych na schizofrenię ze słabą odpowiedzią na klozapinę.
6. Sobów T. Klozapina: między skutecznością a bezpieczeństwem. Psychiatria i Psychologia Kliniczna, 2015, 15.2: 57-60.
7. Aamani M., Kalyan K., Somasundara B. "A Study on Efficacy of CLOZAPINE in Treatment Resistant Schizophrenia." International Journal of Scientific Research, 2016, 4.6.
8. Meder J., Tyszkowska M., Jarema M., Araszkiewicz A., Szafrański T. Leki przeciwpsychotyczne w praktyce lekarza psychiatry. Leczenie pacjentów z rozpoznaniem schizofrenii lekoopornej. Psychiatr Pol, 2008, 6, 859-873.
9. Sommer I.E., Begemann M.J., Temmerman A., Leucht S. Pharmacologica laugmentation strategies for schizophrenia patients with insufficient response to clozapine: a quantitative literaturere - view. Schizophrenia bulletin, 2012, 38(5), 1003-1011.
10. Sobów T., Magierski R., Kłoszewska I. Risperidon jako terapia dodana do klozapiny w schizofrenii opornej na leczenie: meta-analiza randomizowanych badań kontrolowanych przy zastosowaniu placebo, 2009.
11. Petrides G., Malur C., Braga R.J., Bailine S.H., Schooler N.R., Malhotra A.K. et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. American Journal of Psychiatry, 2014, 172(1), 52-58.
12. Zyss T., Rachel W., Datka W., Hese R.T., Gorczyca P., Szwajca K. et al. Obecne miejsce terapii elektrowstrząsowej. Część 2: Aspekt kliniczny. Przegląd Lekarski, 2015, 72(1).
13. Grochowski M. Gdy klozapina nie wystarcza. Postępy Psychiatrii i Neurologii, 2005, 14: 343-352.
14. Alacam, Huseyin, et al. "miR-181b-5p, miR-195-5p and miR-301a-3p are related with treatment resistance in schizophrenia." Psychiatry Research, 2016, 245: 200-206.
15. Barretto P., Kayo E. M., Avrichir M., Sa B.S., Camargo A.R., Napolitano M.D., I. C. et al. A preliminary controlled trial of cognitivebe-havioral therapy in clozapine-resistant schizophrenia. The Journal of nervous and mentaldisease, 2009, 197(11), 865-868.
16. Kołodziej‑Kowalska E., Rabe‑Jabłońska J. Leczenie schizofrenii elektrowstrząsami oraz lekami przeciwpsychotycznymi, łącznie z elektrowstrząsami. Psychiatria i Psychologia Kliniczna, 2011, 11(4), 238-242.
17. Kupchik M., Spivak B., Mester R., Reznik I., Gonen N., Weizman A. et al. Combined electroconvulsive-clozapine therapy. Clinical neuropharmacology, 2000, 23(1), 14-16.
18. Kho K.H., Blansjaar B.A., De Vries S., Babuskova D., Zwinderman A. H., Linszen, D. H. Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia. Europe-anarchives of Psychiatry and Clinical Neuroscience, 2004, 254(6), 372-379.
19. Raffard S., Bortolon C., Macgregor A., Norton J., Boulenger J. P., El Haj, M. et al. Cognitive insight in schizophrenia patients and their-biological parents: A pilot study. Schizophrenia Research, 2016, 159(2), 471-477.
20. Asarnow R.F., Nuechterlein K.H., Fogelson D., Subotnik K.L., Payne D.A., Russell A.T. et al. Schizophrenia and schizophrenia-spectrum personality disorders in the first-degree relatives of children with schizophrenia: the UCLA family study. Archives of General Psychiatry, 2001, 58(6), 581-588.
Downloads
Published
Issue
Section
License
Copyright (c) 2017 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.
