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

Takefumi Suzuki, Gary Remington, Benoit H. Mulsant, Hiroyuki Uchida, Tarek K. Rajji, Ariel Graff-Guerrero, Masaru Mimura, David C. Mamo

Research output: Contribution to journalArticle

95 Citations (Scopus)

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 languageEnglish
Pages (from-to)1-6
Number of pages6
JournalPsychiatry Research
Volume197
Issue number1-2
DOIs
Publication statusPublished - 2012 May 15

Fingerprint

Antipsychotic Agents
Schizophrenia
Therapeutics
Brief Psychiatric Rating Scale
Chlorpromazine

Keywords

  • Antipsychotics
  • Definition
  • Functioning
  • Response
  • Symptoms
  • Treatment-resistant schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

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(1-2), 1-6. https://doi.org/10.1016/j.psychres.2012.02.013

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 journalArticle

Suzuki, Takefumi ; Remington, Gary ; Mulsant, Benoit H. ; Uchida, Hiroyuki ; Rajji, Tarek K. ; Graff-Guerrero, Ariel ; Mimura, Masaru ; Mamo, David C. / Defining treatment-resistant schizophrenia and response to antipsychotics : A review and recommendation. In: Psychiatry Research. 2012 ; Vol. 197, No. 1-2. pp. 1-6.
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