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Treatment refractory schizophrenia.

J P Lindenmayer1

  • 1Psychopharmacology Research Unit, Manhattan Psychiatric Center-Nathan Kline Institute for Psychiatric Research, New York, NY 10035, USA. Lindenmayer@NKI.RFMH.org

The Psychiatric Quarterly
|October 12, 2000
PubMed
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Treatment resistance in schizophrenia is a complex issue. This review examines factors contributing to nonresponse and evaluates atypical antipsychotics and augmentation strategies for refractory patients.

Area of Science:

  • Psychiatry
  • Pharmacology
  • Clinical Neuroscience

Background:

  • Treatment resistance affects a significant portion of schizophrenia patients, posing a major challenge for care.
  • Nonresponsiveness is a multidimensional syndrome involving various symptom clusters and contributing factors.
  • Understanding correlates of nonresponse is crucial for developing effective therapeutic strategies.

Purpose of the Study:

  • To review clinical, demographic, and biological correlates of treatment resistance in schizophrenia.
  • To evaluate the efficacy of atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine) versus typical antipsychotics in treatment-refractory schizophrenia.
  • To critically assess augmentation strategies used for patients unresponsive to standard treatments.

Main Methods:

Related Experiment Videos

  • Systematic review of double-blind studies comparing antipsychotic treatments in treatment-refractory schizophrenia.
  • Analysis of available literature on clinical, demographic, and biological factors associated with treatment resistance.
  • Review of studies on augmentation strategies, noting limitations of open-label and uncontrolled designs.

Main Results:

  • Atypicals show varying effects compared to typicals in treatment-refractory schizophrenia, with clozapine often considered a benchmark.
  • Limited direct comparative data exists between different atypical antipsychotics for this patient group.
  • Augmentation strategies are frequently employed but often lack robust evidence due to study design limitations.

Conclusions:

  • Treatment resistance in schizophrenia requires a multidimensional approach, considering symptoms, patient factors, and comorbidities.
  • While atypical antipsychotics offer options, a subset of patients remains refractory, necessitating further research into effective augmentation.
  • More rigorous, controlled studies are needed to clarify the comparative effectiveness of antipsychotics and augmentation strategies in treatment-resistant schizophrenia.