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.
| Original language | English |
|---|---|
| Pages (from-to) | 1-6 |
| Number of pages | 6 |
| Journal | Psychiatry Research |
| Volume | 197 |
| Issue number | 1-2 |
| DOIs | |
| Publication status | Published - 2012 May 15 |
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Keywords
- Antipsychotics
- Definition
- Functioning
- Response
- Symptoms
- Treatment-resistant schizophrenia
ASJC Scopus subject areas
- Psychiatry and Mental health
- Biological Psychiatry
Cite this
Defining treatment-resistant schizophrenia and response to antipsychotics : A review and recommendation. / Suzuki, Takefumi; Remington, Gary; Mulsant, Benoit H.; Uchida, Hiroyuki; Rajji, Tarek K.; Graff-Guerrero, Ariel; Mimura, Masaru; Mamo, David C.
In: Psychiatry Research, Vol. 197, No. 1-2, 15.05.2012, p. 1-6.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Defining treatment-resistant schizophrenia and response to antipsychotics
T2 - A review and recommendation
AU - Suzuki, Takefumi
AU - Remington, Gary
AU - Mulsant, Benoit H.
AU - Uchida, Hiroyuki
AU - Rajji, Tarek K.
AU - Graff-Guerrero, Ariel
AU - Mimura, Masaru
AU - Mamo, David C.
PY - 2012/5/15
Y1 - 2012/5/15
N2 - 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.
AB - 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.
KW - Antipsychotics
KW - Definition
KW - Functioning
KW - Response
KW - Symptoms
KW - Treatment-resistant schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=84862828607&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862828607&partnerID=8YFLogxK
U2 - 10.1016/j.psychres.2012.02.013
DO - 10.1016/j.psychres.2012.02.013
M3 - Article
C2 - 22429484
AN - SCOPUS:84862828607
VL - 197
SP - 1
EP - 6
JO - Psychiatry Research
JF - Psychiatry Research
SN - 0165-1781
IS - 1-2
ER -