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Refractory schizophrenia: Historical and currently prevailing criteria and definitions

Published online by Cambridge University Press:  16 April 2020

JM Vanelle
JM Vanelle*
Affiliation:
SHU, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014Paris, France
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Summary

Various historical aspects of resistant schizophrenia are described: limitations of treatment efficacy, attempts at proposing therapeutic strategies in non-responding patients, first attempts to define resistance in schizophrenia, and first attempts to distinguish resistance factors. Interest in treatment-refractory schizophrenia was stimulated by several studies in the period 1985–1990, including a pivotal study of clozapine. The need to include biological and psychosocial factors when defining resistance was emphasised by a group who defined a systematic approach to treatment resistance in schizophrenia, including degrees of resistance. The concept of a continuum from full remission to complete refractoriness was proposed by an international study group in 1990. Difficulties in identifying patients with refractory schizophrenia include: variability of schizophrenia diagnostic criteria, lack of consensus concerning good treatment practice with neuroleptic agents, and confusion between resistance, chronicity and severity. A better definition of refractoriness is needed, not only for pharmacological studies but also for a more precise characterisation of a possible subgroup of schizophrenia termed ‘Kraepelinian’.

Keywords

clozapinetreatment-resistant schizophreniahistorydefinitions
Type
Research Article
Information
European Psychiatry , Volume 12 , Issue S5 , 1997 , pp. 321s - 326s
Copyright
Copyright © Elsevier, Paris 1997

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