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. 2019 Dec 19:15:3461-3473.
doi: 10.2147/NDT.S234813. eCollection 2019.

Exploration of Treatment-Resistant Schizophrenia Subtypes Based on a Survey of 204 US Psychiatrists

Christoph U Correll  1   2   3 , Thomas Brevig  4 , Cecilia Brain  4
Affiliations

Exploration of Treatment-Resistant Schizophrenia Subtypes Based on a Survey of 204 US Psychiatrists

Christoph U Correll et al. Neuropsychiatr Dis Treat. .

Abstract

Objective: To explore and describe potential subgroups within the treatment-resistant schizophrenia (TRS) population, using data from a survey of US psychiatrists.

Methods: Psychiatrists completed an online survey of demographic/clinical characteristics and treatment history for two of their patients with TRS. Patients were stratified according to number of suicide attempts, number of hospitalizations, employment status, and TRS onset time frame.

Results: Of the 408 patients with TRS described by psychiatrists, 37.5% had ≥1 suicide attempt, 78.9% had ≥2 hospitalizations, 74.5% were unemployed, 45.0% had TRS onset within 5 years of first treatment (a further 8.0% had TRS from first treatment), and 31.5% had TRS onset after 5 years (15.5% unknown). Patients with ≥1 (vs 0) suicide attempts had statistically significantly more psychiatric (3.6 vs 2.2) and physical (2.2 vs 1.6) comorbidities. Patients with ≥2 (vs ≤1) hospitalizations were statistically significantly more likely to have hallucinations, conceptual disorganization, social withdrawal, and cognitive dysfunction, and had more psychiatric (3.0 vs 1.9) and physical (2.0 vs 1.1) comorbidities. Unemployed (vs employed) patients were statistically significantly more likely to have delusions, hallucinations, blunted affect, social withdrawal, and cognitive dysfunction, and had more psychiatric (2.9 vs 2.3) and physical (2.1 vs 1.2) comorbidities. Patients with TRS onset ≤5 (vs >5) years were statistically significantly younger (35.0 vs 43.7 years), less likely to have hallucinations and social withdrawal, and had fewer psychiatric (2.6 vs 3.3) and physical (1.7 vs 2.3) comorbidities.

Conclusions: Greater clinical burden in TRS is associated with greater illness severity and chronicity markers, suggesting a dimensional gradient from non-TRS to mild-moderate and more severe forms of TRS. Time to onset of TRS may have implications for outcomes, with data indicating greater burden in those with late-onset TRS. Accumulation of illness over time may be more important than time to onset.

Keywords: clinical burden; demography; psychiatry; schizophrenia; surveys and questionnaires; treatment resistance.

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Conflict of interest statement

CUC has been a consultant and/or advisor to or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka. He served on a Data Safety Monitoring Board for Boehringer Ingelheim, Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen, and Takeda. He is a shareholder of LB Pharma. TB and CB are employees of H. Lundbeck A/S. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Psychiatric and physical comorbidities/risk factors or issues experienced by ≥25% of the patients in any TRS subgroup at any point since schizophrenia diagnosis. Notes: *p<0.05, **p<0.01, ***p≤0.001 versus corresponding subgroup. †p<0.05, ††p<0.01 versus >5 years. ‡p<0.05 versus ≤5 years. Abbreviation: TRS, treatment-resistant schizophrenia.
Figure 2
Figure 2
Percentage of patients whose symptoms have a marked to very severe impacta on social and functioning domains by TRS subgroup. Notes: aFor patients who were currently symptomatic, the impact of their symptoms on social and functioning domains was rated as one of “absent”, “mild”, “moderate”, “marked”, “severe”, or “very severe”. bLow number of patients in this subgroup (<30) and therefore ineligible for statistical significance testing. *p<0.05, **p<0.01, ***p≤0.001 versus corresponding subgroup. ††p<0.01 versus >5 years. Abbreviation: TRS, treatment-resistant schizophrenia.
See this image and copyright information in PMC

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