Optimizing Management of Treatment-Resistant Schizophrenia in Japan: Promoting a Refined Clozapine Titration Protocol and Addressing the 'Clozapine Ceiling' through Glutamatergic Modulation.

Limited access to affordable healthcare, high personal healthcare costs and uneven distribution of medical facilities remain persistent challenges in many low and middle income countries []. Within this context, healthcare-seeking behavior is best understood through the framework of health pluralism, where individuals simultaneously engage biomedical, traditional and self-care systems. Closely related is medical syncretism, which reflects the blending of different therapeutic traditions in response to social, cultural and economic realities [, ]. These frameworks emphasize that the continued use of herbal medicine is not a deviation from modern healthcare, but a rational response to structural barriers created by cost, accessibility and perceived quality of care []. Herbal medicine, as a component of complementary and alternative medicine, remains widely used across both developing and high income countries []. In Nigeria, medicinal plants and traditional healing practices play a significant role in primary healthcare delivery, supported by local knowledge systems and the expertise of herbal medicine practitioners [–]. These practices provide accessible, affordable and culturally accepted therapeutic options, while also contributing to pharmaceutical research through the identification of bioactive compounds []. Among commonly utilized species, (Fabaceae) is frequently used in the management of typhoid related symptoms [], whereas (Meliaceae) is widely employed in malaria treatment due to its documented antiplasmodial activity, which inhibits microgametogenesis and disrupt the parasite development [, ]. The sustained use of these plant based therapies reflects their local availability and affordability, as well as strong cultural beliefs, perceived efficacy, and intergenerational knowledge transfer.