Abstract
Substantial evidence supports the use of either clozapine or cognitive-behaviour therapy (CBT) for refractory symptoms of psychosis, and are recommended in many national guidelines. However, the tw...
Highlights
One-third of people diagnosed with schizophrenia continue to have medicationresistant symptoms even after optimal treatment, estimates vary widely from 15% to 20% (McGorry, Killackey, Elkins, Lambert, & Lambert, 2003) to 60% (Elkis, 2007; Gillespie, Samanaite, Mill, Egerton, & MacCabe, 2017)
We examined the referrals that requested clozapine or cognitivebehaviour therapy (CBT), to determine the number of clients who were eligible for both treatments
Clozapine is widely regarded as a treatment of choice for clients with refractory symptoms of psychosis (Haddad & Correll, 2018; National Institute for Health & Care Excellence [NICE], 2014; Siskind, McCartney, Goldschlager, & Kisely, 2016), especially in longer-term and non-industryfunded studies, and compared to first-generation antipsychotic medicines (Samara et al, 2016; Siskind et al, 2016)
Summary
One-third of people diagnosed with schizophrenia continue to have medicationresistant symptoms even after optimal treatment, estimates vary widely from 15% to 20% (McGorry, Killackey, Elkins, Lambert, & Lambert, 2003) to 60% (Elkis, 2007; Gillespie, Samanaite, Mill, Egerton, & MacCabe, 2017). Clozapine is widely regarded as a treatment of choice for clients with refractory symptoms of psychosis (Haddad & Correll, 2018; National Institute for Health & Care Excellence [NICE], 2014; Siskind, McCartney, Goldschlager, & Kisely, 2016), especially in longer-term and non-industryfunded studies, and compared to first-generation antipsychotic medicines (Samara et al, 2016; Siskind et al, 2016). Cognitivebehaviour therapy has shown to be an effective adjunct to non-clozapine medications for a wide variety of patients with schizophrenia, including those with medication-resistant symptoms (Burns, Erickson, & Brenner, 2014). Whether CBT provides improvements for clients already on clozapine is still an open question: two small pilot studies documented short-term improvements in symptoms (Barretto, Kayo, Avrichir, et al, 2009; Pinto, La Pia, Mennella, Giorgo, & DiSimone, 1999). A larger and well-controlled trial of CBT added to clozapine, compared to clozapine-asusual, found a small effect in favour of CBT at end of treatment, but the superiority did not persist at 21-month follow-up (Morrison et al, 2018)
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