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Refractory schizophrenia: Historical and currently prevailing criteria and definitions

Published online by Cambridge University Press:  16 April 2020

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’.

Type
Research Article
Copyright
Copyright © Elsevier, Paris 1997

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References

Bardenat, CSutter, JUn cas de résistance à l'insuline dans le traitement de la schizophrenic 1938 Congres des Aliénistes 346349Google Scholar
Brenner, HDencker, SJGoldstein, Met al.. Defining treatment refractoriness in schizophrenia. Schizophr Bull 1990; 16: 551561CrossRefGoogle Scholar
Christison, GWKirch, DGWyatt, J. When symptoms persist: choosing among alternative somatic treatments for schizophrenia. Schizophr Bull 1991; 17: 217245CrossRefGoogle Scholar
Collins, EJHogan, TPAwad, MD. The pharmacoepidemiology of treatment-refractory schizophrenia. Can J Psychiatry 1992; 37: 192195CrossRefGoogle ScholarPubMed
Davis, JM. Recent development in the drug treatment of schizophrenia. Am J Psychiatric 1976; 133: 208214Google Scholar
Dencker, SJKulhanek, FTreatment resistance in schizophrenia. Braunschweig. Alger: Vieweg, 1988Google Scholar
Deniker, PLoo, HCottereau, MJ. Parenteral loxapine in severely disturbed schizophrenic patients. J Clin Psychiatry 1980; 41: 2326Google ScholarPubMed
Friedel, RO. The combined use of neuroleptics and ECT in drug resistant schizophrenic patients. Psychopharmacol Bull 1986; 22: 928930Google ScholarPubMed
Gujavarty, KGreenberg, LBFink, M. Electroconvulsive therapy and neuroleptic medication in therapy-resistant positive-symptoms psychosis. Convuls Ther 1987; 3: 185195Google ScholarPubMed
Itil, TMKeskiner, AFink, M. Therapeutic studies in ‘therapy resistant’ schizophrenic patients. Compr Psychiatry 1966; 7: 488493CrossRefGoogle Scholar
Jus, AVilleneuve, AJus, KTherapeutic dilemma in neurolepticresistant psychotic disordersDeniker, P, et al.Neuropsychopharmacology, Proceedings of the Tenth Congress of CINP Québec 1976 Wiesbaden: Pergamon Press, 1978; 331338Google Scholar
Kane, JMHonigfeld, GSinger, JMehzer, Hand the Clozaril collaborative Study Group. Clozapine for the treatment-resistant schizophrenia: results of a US multicenter trial. Psychopharmacology 1989; 99: 560563CrossRefGoogle Scholar
Keefe, RSEMohs, RCLosonczy, MFDavidson, MSilverman, JMKendler, KSet al.. Characteristics of very poor outcome schizophrenia. Am J Psychiatry 1987; 144: 889895Google ScholarPubMed
Keefe, RSEMohs, RCDavidson, MLosonczy, MFSilverman, JMLesser, JCet al.. Kraepelinian schizophrenia: a subgroup of schizophrenia. Psychopharmacol Bull 1988; 24: 5661Google ScholarPubMed
Keefe, RSEFreseka, EApter, SHDavidson, MMacaluso, JMHirschowitz, JDavis, KL. Clinical characteristics of Kraepelinian schizophrenia: replication and extension of previous findings. Am J Psychiatry 1996; 153: 806811Google ScholarPubMed
Meltzer, HY. Commentary: defining treatment refractoriness in schizophrenia. Schizophr Bull 1990; 16: 563564CrossRefGoogle Scholar
Meltzer, HYThe etiology and treatment of refractory psychosis 2nd International Conferance, Schizophrenia 1992: Poised for Change Vancouver, Canada 1992Google Scholar
Meltzer, HY. Treatment of the neuroleptic-nonresponsive schizophrenic patient. Schizophr Bull 1992; 18: 515542CrossRefGoogle ScholarPubMed
Merlo, CGGerlach, J. Treatment-resistant schizophrenia. Rev Contemp Pharmacother 1995; 6: 153164Google Scholar
Van Putten, TMarshall, BDLiberman, RMintz, JKuehnel, TGBowen, Let al.. Systematic dosage reduction in treatment-resistant schizophrenic patients. Psychopharmacol Bull 1993; 29: 315320Google ScholarPubMed
Vanelle, JMBrochier, T. Les schizophrénies résistantes. Rapport d'assistance et de thérapeutique. Congres de Psychiatric et de Neurologie de Langue Française de Toulouse, Paris, France 1994; 12: 9293Google Scholar
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