Clinical Psychopharmacology and Neuroscience 2019; 17(4): 559-563  
Efficacy of Asenapine in Schizophrenia Resistant to Clozapine Combined with Electroconvulsive Therapy: A Case Report
Shinichiro Ochi, Saori Inoue, Yuta Yoshino, Hideaki Shimizu, Jun-ichi Iga, Shu-ichi Ueno
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
Correspondence to: Shinichiro Ochi
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
Received: August 3, 2018; Revised: October 22, 2018; Accepted: November 19, 2018; Published online: November 30, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Schizophrenic patients resistant to antipsychotics are diagnosed as having treatment-refractory schizophrenia, and they are treated with clozapine. However, clozapine is sometimes combined with electroconvulsive therapy (ECT) if clozapine monotherapy fails. In this report, a severe treatment-refractory schizophrenic patient who did not respond to clozapine even with ECT, but who recovered with asenapine monotherapy, is presented. Asenapine, considered a serotonin spectrum dopamine modulator, is a new atypical antipsychotic with unique pharmacological features that is used not only for schizophrenia, but also for bipolar disorder. The unique features of asenapine may be effective for some treatment-refractory schizophrenic patients.
Keywords: Asenapine; Treatment-refractory schizophrenia; Clozapine; Electroconvulsive therapy; Suicide; Recurrence.

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