138,174,175 Carbamazepine and valproic acid have been observed to be effective in bipolar disorder176,177 and are often considered as an adjunctive therapy

in patients with schizophrenia. However, these trials included relatively few subjects. Positive effects seen with carbamazepine and valproate have been modest and usually involved nonspecific improvement in areas such as behavior and social adjustment. Carbamazepine should be used with caution because it is a potent enzyme inducer and can also reduce the blood level of haloperidol by as much as 50% .178 Carbamazepine should not be used in combination with lozapine. Inhibitors,research,lifescience,medical There are few data for newer anticonvulsants; however, a few positive results were seen with lamotrigine adjunctive treatment with clozapine.179 Electroconvulsive therapy (EXT) for treatment-refractory schizophrenia Inhibitors,research,lifescience,medical has

had favorable response in shortterm trials when added to antipsychotic medications. However, in spite of more than five decades of widespread clinical use, the administration of ECT lacks a strong research base. A recent literature review180 reports that about 20% patients will have improvement with this combination. Several recent case reports have Inhibitors,research,lifescience,medical noted improvements and controlled trials are currently underway.181,185 The combined treatment with clozapine appears to be well tolerated and associated with few adverse effects. However, the issues of persistence of effect and long-term find more maintenance of these patients have not yet been adequately Inhibitors,research,lifescience,medical addressed. Combined antipsychotic therapy has recently drawn some attention, as many patients (approximately 15%) currently are treated in this way.186 While this use is growing, little research is available to support this treatment approach.187 The most consistent data thus far come from a few case reports suggesting added improvements to clozapine treatment by the addition of risperidone.188-192 Two cases of olanzapine addition to clozapine Inhibitors,research,lifescience,medical have

reported favorable results.193 There is report of the combined use of risperidone and olanzapine with success.194 Other reports include the addition of pimozide, sulpiride, nd loxapine to treatment-resistant patients Mephenoxalone treated with clozapine.195-198 The addition of a antipsychotic with D2blocking abilities may enhance clozapine treatment in partial responders, but large-scale studies are needed. Other adjunctive therapies reported are associated with very little data or have not been clearly found to be useful for treating symptoms of schizophrenia. There have been some reports of benzodiazepines,130,199 but no clear benefits in symptoms other than associated anxiety have been found.128,131,200,201 There are historical studies suggesting that β-blockers may be useful in refractory schizophrenia.