Defining treatment-resistant schizophrenia and response to antipsychotics: A review and recommendation

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• 作者：Takefumi Suzuki^a ; ^{takefumi@oak.dti.ne.jp} ; Gary Remington^b ; ^c ; Benoit H. Mulsant^b ; ^d ; Hiroyuki Uchida^a ; ^d ; Tarek K. Rajji^b ; ^d ; Ariel Graff-Guerrero^b ; ^e ; Masaru Mimura^a ; David C. Mamo^b ; ^d ; ^e
• 关键词：Antipsychotics ; Definition ; Functioning ; Response ; Symptoms ; Treatment-resistant schizophrenia
• 刊名：Psychiatry Research
• 出版年：2012
• 期刊代码：225_01651781
• 类别：med
• 出版时间：15 May, 2012
• 卷：197
• 期：1-2
• 页码：1-6
• 文件大小：217 K

摘要

Treatment-resistant schizophrenia (TRS) has been defined mainly by severity of (positive) symptoms and response to antipsychotics derived from a relative change in the representative scales (most frequently 鈮?#xA0;20%decrease in the Positive and Negative Syndrome Scale: PANSS), but these definitions have not necessarily been consistent. Integrating past evidence and real-world practicability, we propose that TRS be defined by at least two failed adequate trials with different antipsychotics (at chlorpromazine-equivalent doses of 鈮?#xA0;600 mg/day for 鈮?#xA0;6 consecutive weeks) that could be retrospective or preferably include prospective failure to respond to one or more antipsychotic trials. In addition, our proposed criteria require both a score of 鈮?#xA0;4 on the Clinical Global Impression (CGI)-Severity and a score of 鈮?#xA0;49 on the Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz) or 鈮?#xA0;50 on the Global Assessment of Functioning (GAF) scales to define TRS. Once TRS is established, we propose that subsequent treatment response be defined based on a CGI-Change score of 鈮?#xA0;2, a 鈮?#xA0;20%decrease on the total PANSS or Brief Psychiatric Rating Scale (BPRS) scores, and an increase of 鈮?#xA0;20 points on the FACT-Sz or GAF. While these suggestions provide a pragmatic framework for TRS classification, they need to be tested in future trials.