Section - Quick Takes

04. Third-Generation Antipsychotics in Patients With Schizophrenia and Nonresponsivity or Intolerance to Clozapine Regimen: What Is the Evidence?

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

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

When clozapine has been optimized yet psychosis persists, few data are available to guide your next move.
Case series and case reports support consideration of cariprazine, brexpiprazole, and good old aripiprazole (oral or injectable).
First, apply the old adage: When your treatment isn’t working, reconsider your diagnosis.

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What are you supposed to do if you’ve prescribed clozapine for a patient with a diagnosis of schizophrenia and have optimized the dose and they’re still not better or better enough? Well, here’s a new review of your options. What do you predict it will suggest?

Hi! Jim Phelps here for the Psychopharmacology Institute. Most patients with a diagnosis of schizophrenia will have received clozapine after a couple of tries on oral second-generation antipsychotics, right? So, why expect better results from going back in that direction. And yet, what other direction is there? Ah, there’s forward to the expensive stuff—lumateperone, cariprazine, brexpiprazole, and aripiprazole in its injectable form. To help address this question of what’s best to do when clozapine isn’t enough, we have a review by Octavian Vasiliu from Bucharest in Romania. Before going further, I should remind you that several studies now show that getting on clozapine earlier

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05. Olanzapine/Samidorphan in Young Adults With Schizophrenia, Schizophreniform Disorder, or Bipolar I Disorder Who Are Early in Their Illness: Results of the Randomized, Controlled ENLIGHTEN-Early Study

Learning Objectives:

Evaluate the results of a network meta-analysis of treatment options for psychosis in Parkinson’s disease.
Discuss treatment options for insomnia using the recommendations of the American Association for Sleep Medicine and other guides.
Evaluate pharmaceutical options for reducing cocaine craving.
Examine the evidence regarding pharmacologic options after clozapine in treatment-resistant schizophrenia.
Discuss the potential benefits of olanzapine–samidorphan for managing weight gain in patients with first-episode psychosis.

Original Release Date: June 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: June 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.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
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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.