What to Do When Evidence-Based Therapies Fail: Treatment-Resistant and Treatment-Refractory Schizophrenia

This activity is designed for general, pediatric and geriatric psychiatrists, neurologists, nurse practitioners, physician assistants, nurses, psychologists, social workers, other mental health professionals and primary care clinicians interested in treating patients tardive dyskinesia or Parkinson’s Disease.

Supported by educational grants from:

Alkermes, Inc., and Sunovion Pharmaceuticals Inc.

Activity Information


Original Release Date: February 28, 2019
Expiration Date: February 28, 2020
Estimated Time to Complete Activity: 1.0 hour




Program Overview

About 30% of patients with schizophrenia have positive symptoms that are resistant or refractory to treatments with antipsychotic monotherapy. Physicians should consider the adequacy of the previous drug treatment, adherence to therapy, and the existence of other disorders that may cause psychosis. In addition, some therapies have shown positive or mixed results in clinical trials and may be helpful for some patients.




Henry A. Nasrallah, MD
Professor and Chairman
Sydney W. Souers Endowed Chair
Department of Psychiatry and Behavioral Neuroscience
Saint Louis University School of Medicine
SSM Saint Louis University Hospital
St. Louis, Missouri

Learning Objectives

At the conclusion of this program, participants should be better able to:

  • Describe the factors to consider when re-examining the diagnosis of schizophrenia when a patient’s positive symptoms do not improve with adequate trials of antipsychotic medications, including clozapine
  • List requirements for an adequate trial of antipsychotic medication
  • Describe the data from clinical trials of various adjunctive agents that may be useful for a patient with refractive or treatment-resistant schizophrenia

Method of Participation

Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a webpage that will allow you to receive your certificate of credit via email or you may print it out at that time.

The online post-test and evaluation can be accessed at https://tinyurl.com/TXRST18

Inquiries about CME accreditation may be directed to the University of Cincinnati at [email protected] or 513-558-3197.

Joint provider statements


This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Cincinnati and Global Academy for Medical Education. The University of Cincinnati is accredited by the ACCME to provide continuing education for physicians.

Physician Credit Designation
The University of Cincinnati designates this Live Activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants Credit Designation
The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Disclosure Information

As part of their efforts to ensure balance, independence, objectivity, and scientific rigor, the joint providers of this CME/CE activity have required the faculty and all others involved in the development of the content to disclose any relationships they may have with commercial companies that have a product or service relevant to this activity.

Faculty Disclosures

In accordance with Accreditation Council for Continuing Medical Education (ACCME) Essential Areas and Policies, information about the relationships of presenters with commercial interests (if any) will be included in materials distributed at the conference.

Henry A. Nasrallah, MD
Has indicated that he received Research Grants from:
Forest,  Forum,  and Otsuka. Dr Nasrallah has been a Consultant for: Acadia, Alkermes, Allergan, Janssen,Lundbeck, Neurocrine, Otsuka, Sunovion, and Teva. He has also been on the Speakers Bureau for: Acadia, Alkermes Janssen, Neurocrine Otsuka, Sunovion, and Teva.

Planning Committee Members

Bruce Gebhardt, MD No Relevant Relationships
Shirley Jones No Relevant Relationships
Ruth Kollmer No Relevant Relationships
Margaret McLaughlin, PhD No Relevant Relationships
Rick Ricer, MD No Relevant Relationships
Susan P. Tyler No Relevant Relationships

Resolution of Conflicts of Interest

In accordance with the ACCME Standards for Commercial Support of CME, University of Cincinnati will implement mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity.

Off-Label Disclosure

The faculty have been instructed to identify investigational drugs or devices or discussion of drugs or devices that is outside of labeling currently approved by the US Food and Drug Administration.

Contact Information for Technical Questions

Please technical questions or concerns to Global Academy for Medical Education at 973-290-8225 or email [email protected].

Copyright Statement

Copyright © 2019 by Global Academy for Medical Education, LLC, Frontline Medical Communications Inc., and its Licensors. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of the Publisher. Global Academy for Medical Education, LLC, University of Cincinnati, Postgraduate Institute for Medicine, and Frontline Medical Communications will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein.