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Review
. 2019 Nov:131:104257.
doi: 10.1016/j.nbd.2018.08.016. Epub 2018 Aug 29.

Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives

Frederick C Nucifora Jr  1 , Edgar Woznica  2 , Brian J Lee  2 , Nicola Cascella  2 , Akira Sawa  2
Affiliations
Review

Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives

Frederick C Nucifora Jr et al. Neurobiol Dis. 2019 Nov.

Abstract

Treatment resistant schizophrenia (TRS) refers to the significant proportion of schizophrenia patients who continue to have symptoms and poor outcomes despite treatment. While many definitions of TRS include failure of two different antipsychotics as a minimum criterion, the wide variability in inclusion criteria has challenged the consistency and reproducibility of results from studies of TRS. We begin by reviewing the clinical, neuroimaging, and neurobiological characteristics of TRS. We further review the current treatment strategies available, addressing clozapine, the first-line pharmacological agent for TRS, as well as pharmacological and non-pharmacological augmentation of clozapine including medication combinations, electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, and psychotherapies. We conclude by highlighting the most recent consensus for defining TRS proposed by the Treatment Response and Resistance in Psychosis Working Group, and provide our overview of future perspectives and directions that could help advance the field of TRS research, including the concept of TRS as a potential subtype of schizophrenia.

Keywords: Brain Imaging; CBT; Clozapine; DBS; Dopamine; ECT; Genetics; Glutamate; Neurobiology; Schizophrenia; Treatment-Resistant; rTMS.

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Conflict of interest statement

Declaration of Interest: the authors have no competing interests to declare.

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