Which medication is indicated for treatment-resistant schizophrenia?

Which medication is indicated for treatment-resistant schizophrenia?

• A. Paliperidone
• B. Clozapine
• C. Risperidone
• D. Olanzapine

Answer: (B)

Treatment-resistant schizophrenia is when a patient does not respond adequately to at least two adequate trials of antipsychotic therapy. Clozapine is uniquely effective in this situation and has been shown to reduce relapse and suicidality where other antipsychotics fail, which is why it is indicated after failure of standard agents. Its pharmacology differs from typical D2-blockers and many other atypicals, with relatively lower D2 occupancy but strong antagonism at serotonin 5-HT2A receptors and activity at other dopamine receptors, helping to reach symptoms that respond poorly to other drugs, including negative symptoms for some patients. Because of the risk of agranulocytosis, clozapine requires regular blood monitoring and safety surveillance, along with monitoring for seizure risk, myocarditis, constipation, and metabolic effects. This safety framework is part of why clozapine is reserved for treatment-resistant cases, making it the best choice in this scenario.

Treatment-resistant schizophrenia is when a patient does not respond adequately to at least two adequate trials of antipsychotic therapy. Clozapine is uniquely effective in this situation and has been shown to reduce relapse and suicidality where other antipsychotics fail, which is why it is indicated after failure of standard agents. Its pharmacology differs from typical D2-blockers and many other atypicals, with relatively lower D2 occupancy but strong antagonism at serotonin 5-HT2A receptors and activity at other dopamine receptors, helping to reach symptoms that respond poorly to other drugs, including negative symptoms for some patients. Because of the risk of agranulocytosis, clozapine requires regular blood monitoring and safety surveillance, along with monitoring for seizure risk, myocarditis, constipation, and metabolic effects. This safety framework is part of why clozapine is reserved for treatment-resistant cases, making it the best choice in this scenario.