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Schizophrenia in remission — Clinical Guidelines

Overview

Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior 2 8. Treatment-resistant schizophrenia (TRS) affects approximately one-third of patients with schizophrenia and is defined by symptoms that do not adequately respond to antipsychotic medications 4 7.

Diagnosis

No diagnostic criteria or recommended tests are detailed in the provided abstracts.

Management

Clozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia (TRS) and should be initiated as soon as possible 1 7.

Non-clozapine augmentation strategies for antipsychotic treatment in TRS include glycine modulatory site agonists, which may improve positive, negative, and total symptoms 1.

Non-invasive stimulation techniques may offer moderate benefit for positive symptoms in TRS 1.

Psychological and psychosocial interventions can be useful as add-on treatments to pharmacotherapy in TRS 3.

For clozapine-resistant schizophrenia, augmentation with mirtazapine or electroconvulsive therapy (ECT) may be considered 5.

Typical antipsychotics remain a therapeutic option for schizophrenia 2.

Special Populations

No information on special populations is available in the provided abstracts.

Key Recommendations

Clozapine is the only approved treatment for treatment-resistant schizophrenia (TRS) and should be initiated promptly to improve outcomes 7. (Evidence: Strong)

Augmentation of antipsychotics with glycine modulatory site agonists may improve positive, negative, and total symptoms in treatment-resistant schizophrenia 1. (Evidence: Moderate)

Non-invasive stimulation may provide moderate benefit for positive symptoms in treatment-resistant schizophrenia 1. (Evidence: Moderate)

Psychological and psychosocial interventions can be considered as add-on treatments for patients with treatment-resistant schizophrenia 3. (Evidence: Moderate)

For patients not responding adequately to clozapine, augmentation strategies such as mirtazapine or ECT may be considered 5. (Evidence: Moderate)

References

1 Carr R, Cannon A, Finelli V, Bukala B, Cimen Y, Filipova P et al.. Non-Clozapine interventions in treatment-resistant schizophrenia: a systematic review and meta-analysis. Molecular psychiatry 2026. link 2 Storman D, Koperny M, Styczeñ K, Datka W, Jaeschke RR. Lurasidone versus typical antipsychotics for schizophrenia. The Cochrane database of systematic reviews 2025. link 3 Salahuddin NH, Schütz A, Pitschel-Walz G, Mayer SF, Chaimani A, Siafis S et al.. Psychological and psychosocial interventions for treatment-resistant schizophrenia: a systematic review and network meta-analysis. The lancet. Psychiatry 2024. link00136-6) 4 Diniz E, Fonseca L, Rocha D, Trevizol A, Cerqueira R, Ortiz B et al.. Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) 2023. link 5 Grover S, Sarkar S, Sahoo S. Augmentation strategies for clozapine resistance: a systematic review and meta-analysis. Acta neuropsychiatrica 2023. link 6 Abel DB, Rand KL, Salyers MP, Myers EJ, Mickens JL, Minor KS. Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure. Schizophrenia bulletin 2023. link 7 Correll CU, Agid O, Crespo-Facorro B, de Bartolomeis A, Fagiolini A, Seppälä N et al.. A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia. CNS drugs 2022. link 8 Hadjulis M, Margariti M, Lazaridou M, Angelidis GF, Fotopoulos V, Markaki L et al.. [Clinical guidelines for the management of schizophrenia: Pharmacological and psychological interventions (III)]. Psychiatrike = Psychiatriki 2018. link 9 Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW et al.. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia bulletin 2010. link 10 Buchanan RW, Kreyenbuhl J, Kelly DL, Noel JM, Boggs DL, Fischer BA et al.. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia bulletin 2010. link

Schizophrenia in remission