Adjuvant Mood Stabilisers for Long-Term Management of Treatment-Resistant Schizophrenia: A Case Report

Treatment-resistant schizophrenia (TRS) is associated with persistent psychotic symptoms, protracted hospital admissions, and significant functional impairment despite adequate trials of antipsychotic treatment. Optimisation of antipsychotic medication, particularly clozapine-based treatment regimens, alongside multidisciplinary inpatient rehabilitation, is one of the mainstays for improving outcomes in difficult-to-treat schizophrenic presentations. Persistent symptoms despite clozapine treatment have been shown to improve with adjunctive mood stabilisers, especially when there is affective instability. This retrospective case report describes individuals with long-standing TRS receiving care in an inpatient rehabilitation service. Adjunctive mood stabiliser medication was introduced as part of pharmacological optimisation alongside structured rehabilitative interventions for maximum symptom control. Following this approach, gradual improvements were observed in symptom control and engagement with rehabilitation. These cases highlight the potential benefit of mood stabiliser augmentation, such as Lamotrigine or Valproate, in difficult-to-treat presentations, particularly where there is a prominent affective component. Integrated multidisciplinary inpatient rehabilitation and pharmacological optimisation are essential for achieving sustained symptom control and functional recovery in complex psychiatric presentations.