[Treatment refractory schizophrenia]

Historically, first case-report of resistant schizophrenia were described under insulin therapy. Later on, the development of classical neuroleptics has permitted a better outcome but the persistence of a lack of improvement in certain patients has induced the individuation of treatment-refractory schizophrenia criteria. The difficulties in defining the refractory schizophrenic patients are described: variability of the schizophrenia diagnostic criteria, variability of outcome, lack of consensus about the good practices in neuroleptic treatment, difficulties in defining response criteria and the confusion between resistance, chronicity and severity. Three kinds of treatment refractory schizophrenia criteria are available: by Kane et al., May et Dencker, Brenner Dencker et al. There are few studies including resistant schizophrenic patients: their results are not homogeneous, perhaps because the prevalence of treatment-refractory schizophrenia is poorly known, with ranges from 5 to 25%. The following factors are hypothesized as being readily associated to a poor outcome and perhaps resistance: male sex, early illness beginning, severity of negative or formal thought disorder, absence of an affective syndrome, morphological CT scans abnormalities, pharmacological factors, late treatment initiation, variability of biodisposibility... Then the therapeutic point of view is considered under three main axes: neuroleptic drugs (NLP) are the basis of chemotherapy, but other therapeutic approaches complete the biological treatment: coherent institutional work and implication of family environment.(ABSTRACT TRUNCATED AT 250 WORDS)