Treatment-ResistantSchizophrenia: TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology

Oliver D. Howes, Rob McCutcheon, Ofer Agid, Andrea De Bartolomeis, Nico J.M. Van Beveren, Michael L. Birnbaum, Michael A.P. Bloomfield, Rodrigo A. Bressan, Robert W. Buchanan, William T. Carpenter, David J. Castle, Leslie Citrome, Zafiris J. Daskalakis, Michael Davidson, Richard J. Drake, Serdar Dursun, Bjørn H. Ebdrup, Helio Elkis, Peter Falkai, W. Wolfgang FleischackerAry Gadelha, Fiona Gaughran, Birte Y. Glenthøj, Ariel Graff-Guerrero, Jaime E.C. Hallak, William G. Honer, James Kennedy, Bruce J. Kinon, Stephen M. Lawrie, Jimmy Lee, F. Markus Leweke, James H. MacCabe, Carolyn B. McNabb, Herbert Meltzer, Hans Jürgen Möller, Shinichiro Nakajima, Christos Pantelis, Tiago Reis Marques, Gary Remington, Susan L. Rossell, Bruce R. Russell, Cynthia O. Siu, Takefumi Suzuki, Iris E. Sommer, David Taylor, Neil Thomas, Alp Üçok, Daniel Umbricht, James T.R. Walters, John Kane, Christoph U. Correll

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. Method: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Results: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting ofminimumadherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. Conclusions: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.

Original languageEnglish
Pages (from-to)216-229
Number of pages14
JournalAmerican Journal of Psychiatry
Volume174
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1
Externally publishedYes

Fingerprint

Terminology
Psychotic Disorders
Consensus
Guidelines
Therapeutics
Antipsychotic Agents
Schizophrenia
Benchmarking
Research
Randomized Controlled Trials

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Treatment-ResistantSchizophrenia : TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. / Howes, Oliver D.; McCutcheon, Rob; Agid, Ofer; De Bartolomeis, Andrea; Van Beveren, Nico J.M.; Birnbaum, Michael L.; Bloomfield, Michael A.P.; Bressan, Rodrigo A.; Buchanan, Robert W.; Carpenter, William T.; Castle, David J.; Citrome, Leslie; Daskalakis, Zafiris J.; Davidson, Michael; Drake, Richard J.; Dursun, Serdar; Ebdrup, Bjørn H.; Elkis, Helio; Falkai, Peter; Fleischacker, W. Wolfgang; Gadelha, Ary; Gaughran, Fiona; Glenthøj, Birte Y.; Graff-Guerrero, Ariel; Hallak, Jaime E.C.; Honer, William G.; Kennedy, James; Kinon, Bruce J.; Lawrie, Stephen M.; Lee, Jimmy; Leweke, F. Markus; MacCabe, James H.; McNabb, Carolyn B.; Meltzer, Herbert; Möller, Hans Jürgen; Nakajima, Shinichiro; Pantelis, Christos; Marques, Tiago Reis; Remington, Gary; Rossell, Susan L.; Russell, Bruce R.; Siu, Cynthia O.; Suzuki, Takefumi; Sommer, Iris E.; Taylor, David; Thomas, Neil; Üçok, Alp; Umbricht, Daniel; Walters, James T.R.; Kane, John; Correll, Christoph U.

In: American Journal of Psychiatry, Vol. 174, No. 3, 01.03.2017, p. 216-229.

Research output: Contribution to journalArticle

Howes, OD, McCutcheon, R, Agid, O, De Bartolomeis, A, Van Beveren, NJM, Birnbaum, ML, Bloomfield, MAP, Bressan, RA, Buchanan, RW, Carpenter, WT, Castle, DJ, Citrome, L, Daskalakis, ZJ, Davidson, M, Drake, RJ, Dursun, S, Ebdrup, BH, Elkis, H, Falkai, P, Fleischacker, WW, Gadelha, A, Gaughran, F, Glenthøj, BY, Graff-Guerrero, A, Hallak, JEC, Honer, WG, Kennedy, J, Kinon, BJ, Lawrie, SM, Lee, J, Leweke, FM, MacCabe, JH, McNabb, CB, Meltzer, H, Möller, HJ, Nakajima, S, Pantelis, C, Marques, TR, Remington, G, Rossell, SL, Russell, BR, Siu, CO, Suzuki, T, Sommer, IE, Taylor, D, Thomas, N, Üçok, A, Umbricht, D, Walters, JTR, Kane, J & Correll, CU 2017, 'Treatment-ResistantSchizophrenia: TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology', American Journal of Psychiatry, vol. 174, no. 3, pp. 216-229. https://doi.org/10.1176/appi.ajp.2016.16050503
Howes, Oliver D. ; McCutcheon, Rob ; Agid, Ofer ; De Bartolomeis, Andrea ; Van Beveren, Nico J.M. ; Birnbaum, Michael L. ; Bloomfield, Michael A.P. ; Bressan, Rodrigo A. ; Buchanan, Robert W. ; Carpenter, William T. ; Castle, David J. ; Citrome, Leslie ; Daskalakis, Zafiris J. ; Davidson, Michael ; Drake, Richard J. ; Dursun, Serdar ; Ebdrup, Bjørn H. ; Elkis, Helio ; Falkai, Peter ; Fleischacker, W. Wolfgang ; Gadelha, Ary ; Gaughran, Fiona ; Glenthøj, Birte Y. ; Graff-Guerrero, Ariel ; Hallak, Jaime E.C. ; Honer, William G. ; Kennedy, James ; Kinon, Bruce J. ; Lawrie, Stephen M. ; Lee, Jimmy ; Leweke, F. Markus ; MacCabe, James H. ; McNabb, Carolyn B. ; Meltzer, Herbert ; Möller, Hans Jürgen ; Nakajima, Shinichiro ; Pantelis, Christos ; Marques, Tiago Reis ; Remington, Gary ; Rossell, Susan L. ; Russell, Bruce R. ; Siu, Cynthia O. ; Suzuki, Takefumi ; Sommer, Iris E. ; Taylor, David ; Thomas, Neil ; Üçok, Alp ; Umbricht, Daniel ; Walters, James T.R. ; Kane, John ; Correll, Christoph U. / Treatment-ResistantSchizophrenia : TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. In: American Journal of Psychiatry. 2017 ; Vol. 174, No. 3. pp. 216-229.
@article{e85f5a70f5894ec187c9b7b048f77300,
title = "Treatment-ResistantSchizophrenia: TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology",
abstract = "Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. Method: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Results: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50{\%}) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5{\%}) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting ofminimumadherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. Conclusions: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.",
author = "Howes, {Oliver D.} and Rob McCutcheon and Ofer Agid and {De Bartolomeis}, Andrea and {Van Beveren}, {Nico J.M.} and Birnbaum, {Michael L.} and Bloomfield, {Michael A.P.} and Bressan, {Rodrigo A.} and Buchanan, {Robert W.} and Carpenter, {William T.} and Castle, {David J.} and Leslie Citrome and Daskalakis, {Zafiris J.} and Michael Davidson and Drake, {Richard J.} and Serdar Dursun and Ebdrup, {Bj{\o}rn H.} and Helio Elkis and Peter Falkai and Fleischacker, {W. Wolfgang} and Ary Gadelha and Fiona Gaughran and Glenth{\o}j, {Birte Y.} and Ariel Graff-Guerrero and Hallak, {Jaime E.C.} and Honer, {William G.} and James Kennedy and Kinon, {Bruce J.} and Lawrie, {Stephen M.} and Jimmy Lee and Leweke, {F. Markus} and MacCabe, {James H.} and McNabb, {Carolyn B.} and Herbert Meltzer and M{\"o}ller, {Hans J{\"u}rgen} and Shinichiro Nakajima and Christos Pantelis and Marques, {Tiago Reis} and Gary Remington and Rossell, {Susan L.} and Russell, {Bruce R.} and Siu, {Cynthia O.} and Takefumi Suzuki and Sommer, {Iris E.} and David Taylor and Neil Thomas and Alp {\"U}{\cc}ok and Daniel Umbricht and Walters, {James T.R.} and John Kane and Correll, {Christoph U.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1176/appi.ajp.2016.16050503",
language = "English",
volume = "174",
pages = "216--229",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "3",

}

TY - JOUR

T1 - Treatment-ResistantSchizophrenia

T2 - TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology

AU - Howes, Oliver D.

AU - McCutcheon, Rob

AU - Agid, Ofer

AU - De Bartolomeis, Andrea

AU - Van Beveren, Nico J.M.

AU - Birnbaum, Michael L.

AU - Bloomfield, Michael A.P.

AU - Bressan, Rodrigo A.

AU - Buchanan, Robert W.

AU - Carpenter, William T.

AU - Castle, David J.

AU - Citrome, Leslie

AU - Daskalakis, Zafiris J.

AU - Davidson, Michael

AU - Drake, Richard J.

AU - Dursun, Serdar

AU - Ebdrup, Bjørn H.

AU - Elkis, Helio

AU - Falkai, Peter

AU - Fleischacker, W. Wolfgang

AU - Gadelha, Ary

AU - Gaughran, Fiona

AU - Glenthøj, Birte Y.

AU - Graff-Guerrero, Ariel

AU - Hallak, Jaime E.C.

AU - Honer, William G.

AU - Kennedy, James

AU - Kinon, Bruce J.

AU - Lawrie, Stephen M.

AU - Lee, Jimmy

AU - Leweke, F. Markus

AU - MacCabe, James H.

AU - McNabb, Carolyn B.

AU - Meltzer, Herbert

AU - Möller, Hans Jürgen

AU - Nakajima, Shinichiro

AU - Pantelis, Christos

AU - Marques, Tiago Reis

AU - Remington, Gary

AU - Rossell, Susan L.

AU - Russell, Bruce R.

AU - Siu, Cynthia O.

AU - Suzuki, Takefumi

AU - Sommer, Iris E.

AU - Taylor, David

AU - Thomas, Neil

AU - Üçok, Alp

AU - Umbricht, Daniel

AU - Walters, James T.R.

AU - Kane, John

AU - Correll, Christoph U.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. Method: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Results: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting ofminimumadherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. Conclusions: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.

AB - Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. Method: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Results: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting ofminimumadherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients. Conclusions: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.

UR - http://www.scopus.com/inward/record.url?scp=85014440556&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014440556&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.2016.16050503

DO - 10.1176/appi.ajp.2016.16050503

M3 - Article

C2 - 27919182

AN - SCOPUS:85014440556

VL - 174

SP - 216

EP - 229

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 3

ER -