Teach me according to amc gyidelines. Schizo on risperidone and olanzapine not responding, what to do 1. Change to clozapine 2. Increase olanzapine © AMC4IMGs. All rights reserved. Unauthorised use, recording, reproduction, or distribution of content is strictly prohibited under international copyright law. 15 A patient is considered to have treatment-resistant schizophrenia if they meet all the following criteria • moderate or severe positive, negative or cognitive symptoms of psychosis for 12 weeks or longer • moderate or severe functional impairment • monotherapy with 2 antipsychotics given at adequate doses (ie a dose equivalent to 600 mg per day of chlorpromazine) for at least 6 weeks each • adherent to antipsychotic therapy—ie taken at least 80% of the time, as demonstrated by 2 sources (eg pill counts, checking antipsychotic blood concentration [Note 2] [Note 3]); ideally, a long-acting injectable antipsychotic should be used for at least 4 months to confirm adherence and achieve steady-state antipsychotic concentration. If a patient has treatment-resistant schizophrenia, refer to a psychiatrist for review; clozapine may be indicated. © AMC4IMGs. All rights reserved. Unauthorised use, recordi
Treatment-Resistant Schizophrenia (TRS) - AMC Guidelines
Definition of TRS (all criteria must be met):
| Criterion | Detail |
|---|---|
| Symptoms | Moderate/severe positive, negative, or cognitive symptoms for ≥12 weeks |
| Functional impairment | Moderate or severe |
| Two failed antipsychotics | Each given as monotherapy at adequate dose (≥600 mg/day chlorpromazine equivalent) for ≥6 weeks each |
| Adherence confirmed | Taken ≥80% of the time, confirmed by 2 sources (pill counts, blood levels, or LAI for ≥4 months) |
Why This Patient Meets TRS Criteria:
- Failed risperidone (adequate trial)
- Failed olanzapine (adequate trial)
- Two antipsychotics trialed = TRS definition met
Management:
- AMC guidelines explicitly state: "If a patient has treatment-resistant schizophrenia, refer to a psychiatrist for review; clozapine may be indicated."
- Clozapine is the only evidence-based treatment for TRS and has demonstrated superiority over all other antipsychotics in this setting.
- Simply increasing olanzapine (option 2) is incorrect - dose escalation beyond therapeutic range does not improve efficacy and increases side effects. The patient has already failed olanzapine at adequate doses.
Key AMC Exam Points on Clozapine:
- Requires regular FBC monitoring due to risk of agranulocytosis (most feared side effect)
- Other side effects: weight gain, metabolic syndrome, hypersalivation, seizures (dose-dependent), myocarditis (first 4 weeks - monitor CRP, troponin)
- Must be prescribed through a clozapine monitoring program in Australia (e.g., CPMS)
- Baseline: FBC, fasting glucose, lipids, ECG, weight, BP before starting