Table 5.
Psychosocial augmentation strategies in clozapine-resistant schizophrenia
|
Ref.
|
Study/participants |
Interventions
|
Results
|
| Studies | |||
| Pinto et al[69], 1999 | Single-blind RCT of 41 patients with TRS started on clozapine | CBT and social skills training vs supportive therapy for 6 mo. | Significant reductions in positive and negative symptom severity in the CBT group. |
| Buchain et al[70], 2003 | Single-blind RCT of 41 patients with TRS started on clozapine | Occupational therapy and clozapine vs clozapine alone for 6 mo. | Significant improvements in the occupational performance and interpersonal relationships with OT. |
| Barretto et al[71], 2009 | Single-blind RCT of 21 patients with CRS | CBT vs supportive treatment (“befriending”) for 21 wk. | Significant reductions in overall symptom severity and improvement in quality of life with CBT. |
| Morrison et al[75], 2018 | Double-blind RCT of 425 patients with CRS | CBT vs usual treatment for 9 mo. Follow-up for 21 mo. | Significant reductions in PANSS scores with CBT at 9 mo but no differences at 21 mo. |
| Sensky et al[72], 2000; Valmaggia et al[73], 2005; Edwards et al[74], 2011 | RCTs of patients with TRS (n = 48-90) including patients on clozapine or clozapine non-responders | CBT vs supportive treatment or clozapine alone or comparisons with combinations of CBT with other antipsychotics. | Significant reductions in positive, negative, and depressive symptom severity, improvement in clinical response and functioning with CBT; benefits at end of treatment usually maintained during follow-up. |
| Reviews | |||
| Ranasinghe et al[33], 2014 | Systematic review | Review of the 2 CBT and 1 OT trial mentioned above. | Benefits of psychosocial interventions noted for overall symptom severity, quality of life, and social functioning. |
| Polese et al[68], 2019 | Systematic review & meta-analysis | Review of all the above trials and meta-analysis of 4 RCTs including Morrison et al[75]. | Benefits of psychosocial interventions noted for overall and positive symptom severity. |
CBT: Cognitive-behavioural therapy; CRS: Clozapine resistant schizophrenia; PANSS: Positive and Negative Syndrome Scale; OT: Occupational therapy; TRS: Treatment resistant schizophrenia; RCT: Randomized controlled trial.