Psychiatry & Psychotherapy Podcast Clozapine for Treatment Resistant Schizophrenia
Jun 20, 2019
Michael Cummings, a seasoned psychiatrist with expertise in schizophrenia and psychopharmacology, discusses the unique journey of clozapine, the gold standard for treatment-resistant schizophrenia. He reveals its accidental discovery and how initial concerns about side effects delayed its use in the U.S. The conversation covers clozapine's remarkable efficacy, its complex side effects, and the critical need for careful monitoring. Cummings emphasizes individualized treatment strategies and outlines the importance of addressing lifestyle factors to enhance patient outcomes.
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Clozapine's Unique Efficacy
- Clozapine is effective for treatment-resistant schizophrenia with a 50-60% response rate.
- Other antipsychotics show only about a 2% response rate in these patients.
Clozapine's Distinct Mechanism
- Clozapine's antipsychotic effect likely stems from modulating glutamate, not dopamine.
- It activates frontal lobe circuits, improving symptoms and cognition unlike typical antipsychotics.
Manage Clozapine Constipation
- Initiate bowel management protocols proactively with clozapine, starting stool softeners and osmotic laxatives.
- Avoid bulk-forming laxatives since they worsen clozapine-induced constipation.
