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Title: Defining treatment-resistant schizophrenia and response to antipsychotics : a review and recommendation
Authors: Suzuki, Takefumi
Remington, Gary
Mulsant, Benoit H.
Uchida, Hiroyuki
Rajji, Tarek K.
Graff-Guerrero, Ariel
Mimura, Masaru
Mamo, David
Keywords: Antipsychotic drugs
Issue Date: 2012
Publisher: Elsevier Ireland Ltd.
Citation: Suzuki, T., Remington, G., Mulsant, B. H., Uchida, H., Rajji, T. K., Graff-Guerrero, A., ... & Mamo, D. C. (2012). Defining treatment-resistant schizophrenia and response to antipsychotics: a review and recommendation. Psychiatry Research, 197(1), 1-6.
Abstract: 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 ≥ 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 ≥ 600 mg/day for ≥ 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 ≥ 4 on the Clinical Global Impression (CGI)-Severity and a score of ≤ 49 on the Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz) or ≤ 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 ≤ 2, a ≥ 20% decrease on the total PANSS or Brief Psychiatric Rating Scale (BPRS) scores, and an increase of ≥ 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.
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