ABSTRACT
One fifth to one third of all people with schizophrenia have core positive symptoms (such as hallucinations, delusions, and thought disorder) which are resistant to antipsychotic treatment. This finding has been consistent over time (1-4). Treatment of patients in this group has remained a persistent public health problem. These patients are highly symptomatic and require extensive periods of hospital care (5). Their care comprises a disproportionately high share of the total cost of treating schizophrenia (6). These facts were the basis for the enthusiasm of clinicians following the demonstration of clozapine’s efficacy in inpatients with treatment-resistant schizophrenia (7). However, clozapine treatment carries with it significant morbidity from serious side metabolic and cardiovascular effects, and the need for continual blood monitoring. There are now many new antipsychotics available. While none have the demonstrated the superior efficacy of clozapine in schizophrenia, a thoughtful approach to use of these agents will maximize their potential benefit for people who do not easily and robustly respond to their first drug treatment strategy.
