ArticleSchizophrenia bulletin2020
Clozapine Combination and Augmentation Strategies in Patients With Schizophrenia -Recommendations From an International Expert Survey Among the Treatment Response and Resistance in Psychosis (TRRIP) Working Group.
Article in Schizophrenia bulletin, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07120477 (Esketamine Versus Crisis Response Planning Versus Enhanced Treatment as Usual for Suicide Prevention), which is not on this map. Cited by 55 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Esketamine Versus Crisis Response Planning Versus Enhanced Treatment as Usual for Suicide Prevention: A Pragmatic Randomized Trial in a Brazilian Municipality (SAVE)
Who cites it
55 citing papers in PubMed, 5 syntheses or guidelines pooled it, 118 citations in OpenAlex.
- Guideline
- Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group.Schizophrenia bulletin · 2023Guideline
- Optimising plasma clozapine levels to improve treatment response: an individual patient data meta-analysis and receiver operating characteristic curve analysis.The British journal of psychiatry : the journal of mental science · 2023Pooled it
- A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia.CNS drugs · 2022Guideline
- A systematic review and meta-analysis of the association between clozapine and norclozapine serum levels and peripheral adverse drug reactions.Psychopharmacology · 2021Pooled it
- Virtual Reality-Assisted Therapy Compared to Cognitive Behavioral Therapy for Patients With Treatment-Resistant Schizophrenia: Assessor-Blind Randomized Controlled Trial.JMIR mental health · 2026Trial
- Effect of group reminiscence therapy combined with cognitive restructuring on middle-aged and elderly participants with schizophrenia.BMC psychiatry · 2026Trial
- Efficacy and safety of transcutaneous auricular vagus nerve stimulation for patients with treatment-resistant schizophrenia with predominantly negative symptoms: a randomized clinical trial and efficacy sensitivity biomarkers.Molecular psychiatry · 2025Trial
- Optimal Treatment of Magnetic Seizure Therapy (MST) in Patients with Clozapine-Resistant Schizophrenia (CRS).Neuropsychiatric disease and treatment · 2025Trial
- N-Acetylcysteine (NAC) in Schizophrenia Resistant to Clozapine: A Double-Blind, Randomized, Placebo-Controlled Trial Targeting Negative Symptoms.Schizophrenia bulletin · 2022Trial
- Characterizing social motivation deficits in treatment-resistant schizophrenia: Evidence from social incentive performance.Psychiatry and clinical neurosciences · 2026Article
- Effectiveness of amisulpride augmentation versus other antipsychotics in clozapine-treated adolescents: a real-world retrospective study.BMC psychiatry · 2026Article
- Article
- Clozapine-induced Myocarditis in Korea: Analysis of a Nationwide Database and Comparison to Other Countries.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2026Article
- Clozapine prescribing in Germany: temporal trends and regional variations, 2012-2022.Schizophrenia (Heidelberg, Germany) · 2026Article
- A clinical control study of modified electroconvulsive therapy and sodium valproate as enhancement strategies for ultra-treatment-resistant schizophrenia.Schizophrenia research. Cognition · 2026Article
- Adult psychiatrists' views on clozapine prescribing for schizophrenia in Germany-an online survey.Therapeutic advances in psychopharmacology · 2026Article
- Health-Related Quality of Life Among Patients with Treatment-Resistant Schizophrenia Receiving Clozapine-Based Therapy in South Kalimantan, Indonesia.Patient preference and adherence · 2026Article
- A Japanese Pregnant Woman With Treatment-Resistant Schizophrenia Who Continued Clozapine With Blood Concentration Monitoring During the Perinatal Period and Had a Healthy Baby: A Case Report.Neuropsychopharmacology reports · 2025Article
- Challenging treatment frontiers: A case of refractory auditory hallucinations to all available therapies.Indian journal of psychiatry · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 6 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence for the management of inadequate clinical response to clozapine in treatment-resistant schizophrenia is sparse. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for treatment strategies for clozapine-refractory patients with schizophrenia.
methodsWe conducted an online survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group. An agreement threshold of ≥75% (responses "agree" + "strongly agree") was set to define a first-round consensus. Questions achieving agreement or disagreement proportions of >50% in the first round, were re-presented to develop second-round final consensus recommendations.
resultsForty-four (first round) and 49 (second round) of 63 TRRIP members participated. Expert recommendations at ≥75% agreement included raising clozapine plasma levels to ≥350 ng/ml for refractory positive, negative, and mixed symptoms. Where plasma level-guided dose escalation was ineffective for persistent positive symptoms, waiting for a delayed response was recommended. For clozapine-refractory positive symptoms, combination with a second antipsychotic (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus. For negative symptoms, waiting for a delayed response was recommended, and as an intervention for clozapine-refractory negative symptoms, clozapine augmentation with an antidepressant reached consensus. For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilizers, and ECT met consensus criteria. For clozapine-refractory aggression, augmentation with a mood-stabilizer or antipsychotic medication achieved consensus. Generally, cognitive-behavioral therapy and psychosocial interventions reached consensus.
conclusionsGiven the limited evidence from randomized trials of treatment strategies for clozapine-resistant schizophrenia (CRS), this consensus-based series of recommendations provides a framework for decision making to manage this challenging clinical situation.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.