A Review of Current Strategies in Treatment-Resistant Schizophrenia: Considering Paliperidone Palmitate LAI With and Without Olanzapine as an Alternative to Clozapine

Abstract Background Schizophrenia is a debilitating mental illness that affects patient’s function and quality of life. Estimates indicate lifetime prevalence 0.48%, causing up to 13.4 million years life burdened by disability. 30% these patients are deemed as having treatment-resident schizophrenia (TRS), subset which do not respond clozapine, the medication designated for TRS. Those clozapine have clozapine-resistant (CRS), requiring further augmentation or multiple antipsychotics. Current limitations Clozapine only has limited formulations available (oral [PO] dissolving [ODT]) substantial side effect burden. Most serious among effects includes agranulocytosis, in some cases can cause severe infections such septicemia. Regular blood draws monitoring this vital prevent dangerous consequence, but place burden on patients, weekly monthly lab work visits. Other common burdensome include tachycardia, hypotension, sialorrhea, weight gain, metabolic syndrome, name few. However, treatment TRS still needed, alternatives must be explored. Proposed Among studies done few compare second-generation antipsychotics head-to-head, those find similar improvement overall symptom antipsychotics, especially olanzapine paliperidone (in particular, palmitate). Due part improved receptor profile medications (especially 5-HT2A, 6, 7) compared they superior with without patient functional Paliperidone palmitate developing spaced apart, allowing minimal impact livelihood, while demonstrating profile. onset action slow, an effective adjunct strategy may initially administer first 6 months until peak expected from palmitate, at point monotherapy preferred. Conclusions Alternative therapies more fewer effects, indicates particularly pursue long-term utilizing unique combination short-term (first months) awaiting efficacy. Funding No