Adjunctive measures

While antipsychotics can clearly protect against relapse, it has also been strongly advocated that additional benefits can be achieved when medication is combined with other forms of management, especially social/family interventions. This principle has considerable support in the literature, (58> although difficulties persist with most studies.

Treatment resistance

Treatment resistance came to prominence following publication of the United States' multicentre clozapine study, (69 one of the most influential studies of recent years. Within an operationally defined concept of treatment resistance, Kane and colleagues found that while 30 per cent of those on clozapine improved, only 4 per cent of those on the comparison regimen of chlorpromazine and benztropine improved (p < 0.001). This was the first time that superior efficacy could be attributed to an antipsychotic drug, although the population to which this conclusion applied was circumscribed and the criteria for 'improvement' were modest.

Although enhanced efficacy has been claimed 'by association' for other new-generation antipsychotics (where comparable efficacy has been shown with clozapine as comparitor), specific tests of their advantages in operationally defined treatment resistance have not always shown these drugs to be superior to standard treatments/66'

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