Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.
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Howes Oliver D, McCutcheon Rob, Agid Ofer, de Bartolomeis Andrea, van Beveren Nico J M, Birnbaum Michael L, Bloomfield Michael A P, Bressan Rodrigo A, Buchanan Robert W, Carpenter William T, Castle David J, Citrome Leslie, Daskalakis Zafiris J, Davidson Michael, Drake Richard J, Dursun Serdar, Ebdrup Bjørn H, Elkis Helio, Falkai Peter, Fleischacker W Wolfgang, Gadelha Ary, Gaughran Fiona, Glenthøj Birte Y, Graff-Guerrero Ariel, Hallak Jaime E C, Honer William G, Kennedy James, Kinon Bruce J, Lawrie Stephen M, Lee Jimmy, Leweke F Markus, MacCabe James H, McNabb Carolyn B, Meltzer Herbert, Möller Hans-Jürgen, Nakajima Shinchiro, Pantelis Christos, Reis Marques Tiago, Remington Gary, Rossell Susan L, Russell Bruce R, Siu Cynthia O, Suzuki Takefumi, Sommer Iris E, Taylor David, Thomas Neil, Üçok Alp, Umbricht Daniel, Walters James T R, Kane John, Correll Christoph U
Аннотация
METHOD: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.
RESULTS: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.
CONCLUSIONS: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.