TY - JOUR
T1 - Treatment-ResistantSchizophrenia
T2 - TreatmentResponse and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology
AU - Howes, Oliver D.
AU - McCutcheon, Rob
AU - Agid, Ofer
AU - De Bartolomeis, Andrea
AU - Van Beveren, Nico J.M.
AU - Birnbaum, Michael L.
AU - Bloomfield, Michael A.P.
AU - Bressan, Rodrigo A.
AU - Buchanan, Robert W.
AU - Carpenter, William T.
AU - Castle, David J.
AU - Citrome, Leslie
AU - Daskalakis, Zafiris J.
AU - Davidson, Michael
AU - Drake, Richard J.
AU - Dursun, Serdar
AU - Ebdrup, Bjørn H.
AU - Elkis, Helio
AU - Falkai, Peter
AU - Fleischacker, W. Wolfgang
AU - Gadelha, Ary
AU - Gaughran, Fiona
AU - Glenthøj, Birte Y.
AU - Graff-Guerrero, Ariel
AU - Hallak, Jaime E.C.
AU - Honer, William G.
AU - Kennedy, James
AU - Kinon, Bruce J.
AU - Lawrie, Stephen M.
AU - Lee, Jimmy
AU - Leweke, F. Markus
AU - MacCabe, James H.
AU - McNabb, Carolyn B.
AU - Meltzer, Herbert
AU - Möller, Hans Jürgen
AU - Nakajima, Shinchiro
AU - Pantelis, Christos
AU - Marques, Tiago Reis
AU - Remington, Gary
AU - Rossell, Susan L.
AU - Russell, Bruce R.
AU - Siu, Cynthia O.
AU - Suzuki, Takefumi
AU - Sommer, Iris E.
AU - Taylor, David
AU - Thomas, Neil
AU - Üçok, Alp
AU - Umbricht, Daniel
AU - Walters, James T.R.
AU - Kane, John
AU - Correll, Christoph U.
PY - 2017/3
Y1 - 2017/3
N2 - Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. 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 ofminimumadherence 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.
AB - Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. 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 ofminimumadherence 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.
UR - http://www.scopus.com/inward/record.url?scp=85014440556&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.2016.16050503
DO - 10.1176/appi.ajp.2016.16050503
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C2 - 27919182
AN - SCOPUS:85014440556
SN - 0002-953X
VL - 174
SP - 216
EP - 229
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
IS - 3
ER -