Section - Quick Takes

03. Augmentation Strategies for Clozapine Resistance: A Systematic Review and Meta-Analysis

Published on March 1, 2023 Certification expiration date: March 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Although a recent review found adjunctive mirtazapine to be one of the best options for clozapine-resistant schizophrenia, that conclusion was based on a single trial and did not account for a second negative trial.
This reminds us that article abstracts alone can be misleading. Before you think about changing your practice based on a stunning finding, dig deeper. This Quick Take presents a (hopefully amusing) example of such excavation.

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For people living with a diagnosis of schizophrenia, in general, negative symptoms have a greater impact on quality of life than positive symptoms. But in general, positive symptoms are the ones that respond better to pharmacologic treatments. Thus, the common clinical challenge: What can you do to address those negative symptoms? In this Quick Take, we’ll skim over the usual options and look at data for one that emerged in a recent review, mirtazapine as an adjunct to an antipsychotic. Warning, the data are very weak. You’re not going to think, “Oh my gosh, a great new treatment option” or “I’ve failed to help people that I might have helped.” Instead, another conclusion—be careful with your interpretations if you’re just looking at an article abstract.

Hi! Jim Phelps here for the Psychopharmacology Institute. This rabbit hole dive began with a review article regarding augmentation strategies in schizophrenia. The abstract concludes

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04. C-Reactive Protein Could Predict the Efficacy of SSRIs in Clinical Practice: A Cohort Study of Large Samples in the Real World

Learning Objectives:

Examine whether baseline cognitive function is a predictor of illness course in first-episode schizophrenia.
Evaluate the research basis for the “3 strikes rule” of antidepressant treatment for recurrent depression.
Discuss the evidence base regarding the efficacy of mirtazapine as an adjunctive agent for the management of clozapine-resistant schizophrenia.
Examine whether C-reactive protein can be a clinically useful predictor of antidepressant response.
Evaluate the efficacy of extract of lavender for the treatment of insomnia.

Original Release Date: March 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: March 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James R Phelps declares the following interests:

- McGraw-Hill: Royalties

- W.W. Norton & Co.: Royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Participants must complete the activity online during the valid credit period that is noted above.

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.