The treatment of resistant schizophrenia

Abstract

Introduction. Schizophrenia is a severe mental disorder characterized by positive, negative and cognitive symptoms. Schizophrenia affects 1% of general population and one of its features is the heterogeneity of response to treatment. 20–30% of individuals with schizophrenia have treatment-resistant schizophrenia. Correctly identifying these patients could contribute to reduce burden in patients themselves, in society and in economy. In fact, TRS constitutes about 60–70% of schizophrenia's cost burden. Three key elements define the concept of treatment resistant schizophrenia. These are: 1) a confirmed diagnosis of schizophrenia based on validated criteria; 2) adequate pharmacological treatment; and 3) persistence of significant symptoms despite this treatment. Aim of the study. Studying the particularities of the clinical evolution and the management methods of the resistant schizophrenia treatment. Materials and methods. The number of patients included in the study is 38 people who were previously diagnosed with schizophrenia. To these patients, the BPRS scale was performed to identify the response to the administered treatment. Also in the study were taken into consideration the following criteria,such as: age, heredity, gender, number of recurrences and admissions, trigger factors, duration of psychotic episode, disease evolution over the years and what antipsychotics were administered. Results. In the study performed on 38 patients, using the BPRS scale, were identified only 3 patients, who meet the criteria of resistant schizophrenia, the patients are male over 45 years old. Now, I am studying patient’s records to analyze other aspects and criteria that influence treatment resistance. By analyzing the treatment that follows, patients develop resistance to typical antipsychotics. A pattern of superiority for olanzapine, clozapine, and risperidone was seen in other efficacy outcomes, but results were not consistent and effect sizes were usually small. In addition, relatively few RCTs were available for antipsychotics other than clozapine, haloperidol, olanzapine, and risperidone. The most surprising finding was that clozapine was not significantly better than most other drugs. Conclusions. The clinical management of patients with treatment-resistant schizophrenia is still challenging despite years of extensive research. 2 antipsychotic drugs should be tried at adequate dosage and for an adequate period, and various factors that interfere with adherence should be ruled out before making a diagnosis of treatment-resistant schizophrenia. Clozapine should be used only when it is confirmed that patients have treatment-resistant schizophrenia and their condition fails to respond to atypical antipsychotics or typical antipsychotics. The same rule applies in identifying clozapine-resistant schizophrenia. Pharmacological augmentation strategies for managing clozapine-resistant schizophrenia are widely used in clinical practice. However, there is no strong evidence that supports augmentation as an effective treatment option. ECT may be an effective augmentation strategy in the treatment of clozapine-resistant schizophrenia. It should be emphasized that psychological and psychosocial care combined with medication treatment are the key factors in maximizing the effectiveness in the treatment of patients with treatment-resistant schizophrenia.