How do you approach treatment-refractory schizophrenia which has not responded to multiple antipsychotic trials including clozapine?  

I have had success using a combination of Clozaril with Invega Sustenna or Abilify Maintena, in the treatment of refractory schizophrenia.

Having personal experience with a family member facing treatment-resistant schizophrenia, I deeply understand the emotional and clinical challenges involved in managing such cases. It can feel overwhelming when a loved one, or a patient, seems stuck in a cycle of non-response despite exhaustive effo...

There’s also some evidence for using memantine in combination with clozapine to treat positive symptoms. I’ve seen some clinical benefits from this combination as well.

Sometimes we can't call it treatment refractory unless we max out on clozapine dose. I have seen some patients' levels pushed to 1,200 to see the benefit. If sedation is an issue we can always add fluvoxamine as a CYP1A2 inhibitor and keep the clozapine dose low to accomplish the same benefit. I ha...

I see a lot of treatment-resistant schizophrenia patients as I work in specialized residential facilities, so basically step-downs from State Hospital. I use a lot of clozapine and Sustenna combo, making sure the clozapine level is not toxic and that the QTC and heart are within normal limits with g...