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Definition of therapy-resistant schizophrenia and its assessment

Published online by Cambridge University Press:  16 April 2020

HD Brenner  and
MCG Merlo
HD Brenner
Affiliation:
Social Psychiatric University Clinic, 3010 Bern, Laupenstrasse 49, Switzerland Psychiatric University Hospital, 3072Ostermundigen, Bolligenstrasse 111, Switzerland
MCG Merlo
Affiliation:
Social Psychiatric University Clinic, 3010 Bern, Laupenstrasse 49, Switzerland Psychiatric University Hospital, 3072Ostermundigen, Bolligenstrasse 111, Switzerland
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Summary

The treatment of nonresponsive schizophrenia poses perennial problems. The situation is made yet more complex when the great variety of patient types, their social background, family circumstances and psychosocial requirements are taken into account. The comparative lack of response to neuroleptic therapy seen in some patients, especially those with minimal structural brain changes, further complicates the problem, provoking—as such therapy may—more EPS than are normally seen in patients without more obvious physical changes in brain structure. Until recently, the treatment of nonresponsive schizophrenia has tended to involve switching from one neuroleptic (usually a “highpotent” agent) to another of different chemical structure. However, as these “typical” neuroleptics occupy D2 receptors, the rationale for using a less conventional antipsychotic, such as clozapine, is increasingly appreciated in the management of the treatment-refractory schizophrenic.

Type
Research Article
Information
European Psychiatry , Volume 10 , Issue S1 , 1995 , pp. 11s - 17s
Copyright
Copyright © Elsevier, Paris 1995

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References

Andreasen, NCThe Scale for the Assessment of Negative Symptoms (SANS) Iowa City: The University of Iowa, 1983Google Scholar
Andreasen, NCDie Behandlung des therapieresistenten schizophrenen PatientenHinterhuber, HKulhanek, FFleischhacker, WWet al.Prädiktoren und Therapieresistenz in der Psychiatrie Braunschweig/Wiesbaden: Vieweg, 1993Google Scholar
American Psychiatric AssociationFourth Edition Diagnostic and Statistical Manual of Mental Disorders Washington: American Psychiatric Association, 1994Google Scholar
Angst, JEuropean long-term follow-up studies of schizophrenia. Schizophr Bull 1988; 14: 501–1410.1093/schbul/14.4.501CrossRefGoogle ScholarPubMed
Asarnow, RFGranholm, ESherman, TSpan of apprehension in schizophreniaSteinhauer, SRGruzelier, JHZubin, JHandbook of Schizophrenia, vol 5: Neuropsychology, Psychophysiology and Information Processing Amsterdam: Elsevier Science Publisher BV, 1991Google Scholar
Breier, AWolkowitz, OMDoran, ARet al.Neuroleptic responsivity of negative and positive symptoms in schizophrenia. Am J Psychiatry 1987; 144: 1549–55Google Scholar
brenner, HDDencker, SJGoldstein, MJet al.Defining treatment refractoriness in schizophrenia. Schizophr Bull 1990; 16: 551–6110.1093/schbul/16.4.551CrossRefGoogle Scholar
Brenner, HDGasser, CHInteraktive Prozesse in der Therapie von PsychosenPlatz, TBrennpunkte der Schizophrenie Berlin: Springer, 1993Google Scholar
Carpenter, WT JrHeinrichs, DWAlphs, LDTreatment of negative symptoms. Schizophr Bull 1985; 11: 440–5210.1093/schbul/11.3.440CrossRefGoogle ScholarPubMed
Convit, AVolavka, JCzobor, Pet al.Effect of subtle neurological dysfunction on response to haloperidol treatment in schizophrenia. Am J Psychiatry 1994; 151: 49–56Google Scholar
Deister, ADie Bedeutung psychosozialer Ansätze in der Behandlung therapieresistenter schizophrener PatientenMöller, HJTherapieresistenz unter Neuroleptikabehandlung Berlin: Springer, 1993Google Scholar
Dencker, SJKulhanek, FTreatment Resistance in Schizophrenia Braunschweig/Wiesbaden: Vieweg, 1988Google Scholar
Dilling, HMombour, WSchmidt, MHWeltgesundheitsorganisation Internationale Klassifikation psychischer Störungen 2 korr Aufl Bern: Huber, 1993Google Scholar
Guy, WECDEU Assessment Manual for Psychopharmacology, revisedDHEW Pub No (ADM) 76-338 Rockville, MD, USA: National Institute of Mental Health, 1976Google Scholar
Hogarty, GEAnderson, CMReiss, DJet al.Family psychocducation, social skills training, and maintenance chemotherapy in the after-care treatment of schizophrenia. II Two-year effects of a controlled study on relapse and adjustment Arch Gen Psychiatry 48 4 1991 340–7CrossRefGoogle Scholar
Kane, JHonigfeld, GSinger, Jet al.Clozapine for the treatment-resistant schizophrenic: A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–9810.1001/archpsyc.1988.01800330013001CrossRefGoogle ScholarPubMed
Lukoff, DLiberman, RPNuechterlein, KHSymptom monitoring in the rehabilitation of schizophrenic patients. Schizophr Bull 1986; 12: 578–60310.1093/schbul/12.4.578CrossRefGoogle ScholarPubMed
Marder, SRMeibach, RCRisperidone in the Treatment of Schizophrenia. Am J Psychiatry 1994; 151: 825–35Google ScholarPubMed
Markstein, RBedeutung neuer Dopaminrezeptoren für die Wirkung von ClozapinNaber, DMüller-Spahn, FClozapin: Pharmakologie und Klinik eines atypischen Neuroleptikums Berlin: Springer, 1994Google Scholar
Marneros, ADeister, ARohde, Aet al.Long term outcome of schizoaffective and schizophrenic disorders: A comparative study. I Definitions, methods, psychopathological and social outcome. Eur Arch Psychiatry Neurol Sci 1989; 238: 118–25CrossRefGoogle ScholarPubMed
Marneros, AAndreasen, MTTsuang, MTNegative versus positive schizophrenia Berlin: Springer, 1991 10.1007/978-3-642-76841-5CrossRefGoogle Scholar
Maurer, KHäfner, HDependence, independence or interdependence of positive and negative symptomsMarneros, AAndreasen, MTTsuang, MTNegative versus Positive Schizophrenia Berlin: Springer, 1991Google Scholar
McGlashan, TA selective review of recent North American longterm follow-up studies of schizophrenia Schizophr Bull 14 (4) 1988 515–4210.1093/schbul/14.4.515CrossRefGoogle Scholar
Meltzer, HYDefining treatment refractoriness in schizophrenia Schizophr Bull 16 (4) 1990 563–5CrossRefGoogle Scholar
Meitzer, HYThe mechanism of action of novel antipsychotic drugs. Schizophr Bull 1991; 17: 263–89CrossRefGoogle Scholar
Möller, HJTypical neuroleptics in the treatment of positive and negative symptomsMarneros, AAndreasen, NCTsuang, MTNegative versus Positive Schizophrenia Berlin: Springer, 1991Google Scholar
Nuchterlein, KHDawson, MEA heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 1984; 10: 300–12CrossRefGoogle Scholar
Nuechterlein, KHVigilance in schizophrenia and related disorders In: Steinhauer, SRGruzelier, JHZubin, JHandbook of schizophrenia, vol 5: Neuropsychology psychophysiology and information processing Amsterdam: Elsevier Science Publications BV, 1991Google Scholar
Overall, JEGorham, DRThe brief psychiatric rating scale. Psychol Rep 1962; 10: 799–812CrossRefGoogle Scholar
Pickar, DOwen, RRLitman, REet al.Clinical and biological response to clozapine in patients with schizophrenia. Crossover comparison with fluphenazine. Arch Gen Psychiary 1992; 49: 345–353CrossRefGoogle Scholar
Rohde, AMarneros, A“Therapieresistenz” schizophrener Erkrankungen im Licht der Langzeitkatamnese: Die persistierenden AlterationenMöller, HJTherapieresistenz unter Neuroleptikabehandlung Berlin: Springer, 1993Google Scholar
seeman, PDopamine receptor sequences. Therapeutic levels of neuroleptics occupy D2 receptors, clozapine occupies D4. Neuropsychopharmacology 1992; 7: 261–84Google ScholarPubMed
Serban, GSiegel, SGaffney, MResponse of negative symptoms of schizophrenia to neuroleptic treatment. J Clin Psychiatry 1992; 53: 229–34Google ScholarPubMed
Spitzer, RLGibbon, MEndicott, JThe Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbances. Arch Gen Psychiatry 1976; 33: 766–71Google Scholar
Tegeler, JVorgehen bei Neuroleptika-NonrespondemMöller, HJTherapie psychiatrischer Erkrankungen Berlin: Springer, 1993Google Scholar
Test, MAKnoedler, WHAllness, DJThe long-term treatment of young schizophrenics in a community support programmeStein, LITest, MAThe training in community living model: a decade of experience New Direction For Mental Health Servicesno 26, San Francisco: Jossey Bass, 1985Google Scholar
Test, MAKnoedler, WHAllness, DJet al. Comprehensive community care of persons with schizophrenia through the Programme of Assertive Community Treatment (PACT) Br J Psychiatry (in press)Google Scholar
Wallace, CJFunctional assessment in rehabilitation Schizophr Bull 24 1986 112–7Google Scholar
World Health Organisation, Disability Assessment Schedule Genf: World Health Organisation, 1987Google Scholar
Zubin, JSpring, BVulnerability. A new view of schizophrenia. J Abnorm Psychol 1977; 86: 103–26CrossRefGoogle ScholarPubMed
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