Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia

John M. Kane, Ofer Agid, Marjorie Baldwin, Oliver Howes, Jean Pierre Lindenmayer, Stephen Marder, Mark Olfson, Steven G. Potkin, Christoph U. Correll

Research output: Contribution to journalArticle

Abstract

Treatment-resistant schizophrenia (TRS) occurs in approximately 30% of individuals diagnosed with schizophrenia. The identification and management of TRS in clinical practice are inconsistent and not evidence based. No established clinically relevant criteria for defining and treating TRS exist, although guidelines have been promulgated for clozapine use among TRS patients. This report summarizes the consensus from a roundtable that focused on defining and identifying TRS, pathways to treatment resistance, current treatments, unmet needs, and disease burden. Nine clinical experts in schizophrenia and TRS participated in a closed meeting on June 23, 2017, sponsored by Lundbeck, at which published literature in key areas of TRS research was reviewed. The findings from published studies were synthesized by experts in each area and presented to the group for review and discussion. It was agreed that inadequate response to 2 different antipsychotics, each taken with adequate dose and duration, is required to establish TRS. This recommendation is consistent with guidelines for clozapine use. For each trial, objective symptom measures should be used to assess treatment response, with medication adherence ensured. Once nonresponse is established (after ≥ 12 weeks for positive symptoms [2 trials of ≥ 6 weeks]), the treatment plan should be reevaluated and alternative pharmacologic or nonpharmacologic treatments considered. With increased awareness, those involved in the care of patients with schizophrenia will be able to identify TRS earlier in its course, thus supporting more informed treatment decisions by clinicians, patients, and caregivers to reduce the overall disease burden.

Original languageEnglish (US)
JournalThe Journal of clinical psychiatry
Volume80
Issue number2
DOIs
StatePublished - Mar 5 2019

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Schizophrenia
Therapeutics
Clozapine
Guidelines
Medication Adherence
Caregivers
Antipsychotic Agents
Consensus
Patient Care

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia. / Kane, John M.; Agid, Ofer; Baldwin, Marjorie; Howes, Oliver; Lindenmayer, Jean Pierre; Marder, Stephen; Olfson, Mark; Potkin, Steven G.; Correll, Christoph U.

In: The Journal of clinical psychiatry, Vol. 80, No. 2, 05.03.2019.

Research output: Contribution to journalArticle

Kane, JM, Agid, O, Baldwin, M, Howes, O, Lindenmayer, JP, Marder, S, Olfson, M, Potkin, SG & Correll, CU 2019, 'Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia' The Journal of clinical psychiatry, vol. 80, no. 2. https://doi.org/10.4088/JCP.18com12123
Kane, John M. ; Agid, Ofer ; Baldwin, Marjorie ; Howes, Oliver ; Lindenmayer, Jean Pierre ; Marder, Stephen ; Olfson, Mark ; Potkin, Steven G. ; Correll, Christoph U. / Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia. In: The Journal of clinical psychiatry. 2019 ; Vol. 80, No. 2.
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