Question: In adults with treatment resistant psychosis, in medium/low secure services, what interventions are effective in improving patient outcomes?

Answer:

Plain language summary

There is limited high quality research available on interventions for treatment resistant psychosis in medium/low secure services. More research is needed to adequately assess effective treatments in this area.

Clinical and research implications

This evidence summary is based on information from two small, poor quality studies, neither of which used a conventional randomised controlled design. Both studies were conducted in long-term male hospital in-patients with schizophrenia. The available evidence indicates that switching from clozapine (or equivalent) to risperidone, or augmentation of neuroleptic medication with lithium carbonate, has no significant effect on symptoms or behaviour. Although Scottish Intercollegiate Guidelines Network (SIGN) guidance recommends consideration of a trial of clozapine augmentation with a second SGA (Second Generation Antipsychotic) for treatment resistant patients, the systematic review on which this recommendation was based found no significant overall treatment effect and only very small treatment effects, which are unlikely to be clinically significant, in the individual included studies.

All of the available evidence in this area is derived from small, poor quality studies. Although there is little or no evidence to support any treatment in addition to or in place of clozapine/'traditional neuroleptics', larger, long-term trials of adjunctive treatments may provide greater certainty.

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