Treatment-resistant schizophrenia is a lack of adequate response to antipsychotic medications resulting in incomplete functional and social recovery from the illness. Different definitions have been proposed for clinical practice and research work. Antipsychotics that are used in the management of schizophrenia mainly act on multiple dopaminergic pathways which are implicated in the development of symptoms of schizophrenia. Newer antipsychotics also are implicated to affect the serotonergic pathways. Clozapine is the only evidence-based treatment available for the management of treatment-resistant cases. Neurobiologically, there is a considerable overlap between treatment-resistant and treatment-responsive cases. The factors that are implicated in the evolution of treatment resistance are still not conclusive. These make the management of such patients a challenge. However, certain peculiarities of treatment-resistant schizophrenia have been identified which can guide us in the early identification and precise treatment of the treatment-resistant cases.

Bipolar Disorder is a major mental illness characterized by episodic occurrence of mood symptoms which can be of mania, depression or a mixed episode. The role of Uric Acid in the etiopathogenesis of episodic mental illnesses might be considered recognized long back in 19th century. Lithium was used as treatment for gouty arthritis and that in some cases helped to control mental illnesses. Multiple role of uric acid in the Central Nervous System have been recognized now. In the present study 30 patients in manic episodes were included and their serum Uric Acid level was compared to age and sex matched healthy controls twice at the interval of three weeks. It was found that Uric Acid level of cases was significantly higher than in controls before the initiation of treatment. Uric Acid level of manic group showed a significant decline after three weeks of treatment initiation. There was no significant change in Uric Acid level of control group after three weeks Serum Uric Acid levels are elevated during manic phase of Bipolar Disorder and decreases after initiation of treatment. There may be more research to find whether uric acid can be considered a biomarker for Bipolar illnesses and also an indicator for treatment response.