Early Initiation of Clozapine Treatment and Psychotherapy for the First Episode of Schizophrenia, a Case Report from an Inpatient Unit of an Early Intervention Program.
Poster B63, Friday, October 21, 11:30 am - 1:00 pm, Le Baron
Carmen Paz Castañeda1, Carlos Gallardo1,3, Rubén Nachar1,2, Alfonso González1,2, Cristián Mena1; 1Early Intervention Program. J. Horwitz Psychiatric Institute. Santiago, Chile., 2Finis Terrae University. Santiago,Chile., 3Diego Portales University Psychological Clinic. Santiago, Chile
The use of Clozapine for treatment-resistant clients experiencing a first episode of psychosis (FEP) has proven effective and been widely adopted in the last ten years (Edwards, 2011). According to the Chilean Technical Norm for the Use of Clozapine (2000) the prescription of this medication should be considered after the trial of at least two antipsychotics for at least ten weeks and in a sufficient doses to comply with a treatment resistance criteria. Despite this recommendation and considering the severity of the FEP treated in our service, we decided to indicate Clozapine in clients with little or no response to other antipsychotics before the standard ten weeks, which represent nearly 10% of treated clients (González, 2015). Our decision is based not only on our interest in symptom remission but also on the potential for establishment of an early psychotherapeutic support tailored to the client´s needs. This treatment constitutes an alternative to the use of electroconvulsive therapy (ECT), which is explicitly recommended by the Minsal Guide (2009). We review the case of a client who presented with severe catatonic and pseudo-obsessive symptoms accompanied by persistent psychotic anguish associated with suicidal ideation. Confronted with a poor response to a combined schema of atypical antipsychotics and benzodiazepines, we initiated Clozapine. The reduction of psychotic anguish and stereotyped behavior paved the road to a psychotherapeutic dialogue which enabled the client to report his discomfort and subjective experience. This case highlights the efficacy of an alternative treatment to ECT which permits an early psychotherapeutic intervention.
Topic Area: Psychopharmacology