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Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives

Frederick C Nucifora1, Edgar Woznica1, Brian J Lee1

  • 1Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA.

Neurobiology of Disease
|September 1, 2018
PubMed

Insights

Treatment resistant schizophrenia (TRS) remains a challenge, with varied definitions impacting research. This review covers TRS characteristics, treatments like clozapine, and proposes a new consensus definition for advancing research.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Research

Background:

  • Treatment resistant schizophrenia (TRS) affects a significant patient population, characterized by persistent symptoms despite adequate antipsychotic trials.
  • Inconsistent definitions of TRS hinder research reproducibility and clinical consistency.
  • Understanding the clinical, neuroimaging, and neurobiological features of TRS is crucial.

Purpose of the Study:

  • To review the clinical, neuroimaging, and neurobiological characteristics of Treatment Resistant Schizophrenia (TRS).
  • To summarize current and emerging treatment strategies for TRS, including clozapine and augmentation therapies.
  • To present the latest consensus on defining TRS and discuss future research directions.

Main Methods:

  • Literature review of clinical studies, neuroimaging research, and neurobiological investigations related to TRS.
  • Analysis of pharmacological (clozapine, augmentation) and non-pharmacological (ECT, TMS, DBS, psychotherapy) treatment modalities.
  • Evaluation of proposed consensus criteria for defining TRS.

Main Results:

  • TRS exhibits distinct clinical, neuroimaging, and neurobiological profiles.
  • Clozapine is the established first-line treatment, with various augmentation strategies showing promise.
  • A new consensus definition for TRS has been proposed to improve research consistency.

Conclusions:

  • Standardizing the definition of TRS is essential for advancing research and clinical practice.
  • A multimodal treatment approach, including clozapine and augmentation, is key for managing TRS.
  • Future research should explore TRS as a potential distinct subtype of schizophrenia.
Keywords:
Brain ImagingCBTClozapineDBSDopamineECTGeneticsGlutamateNeurobiologySchizophreniaTreatment-ResistantrTMS

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