We thank Drs Bhatara, Gupta, and Flugsrud-Breckenridge for their interest in our article. Their case presentation brings up a number of points with regard to the management of treatment-resistant childhood-onset schizophrenia that is unresponsive to clozapine. As they suggest, poor response to clozapine may be due to inadequate dosage. However, alternate explanations such as drug interactions, poor compliance, comorbid substance abuse, failure to treat affective symptoms, excessive dosage resulting in adverse effects that outweigh therapeutic effects, and delayed response to clozapine should also be considered.1
Kumra S, Jacobsen LK, Rapoport JL. Childhood-Onset Schizophrenia—Reply. Arch Gen Psychiatry. 1998;55(1):91–92. doi:10.1001/archpsyc.55.1.91
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