Treatment-resistant schizophrenia (TRS) occurs in approximately 30% of individuals diagnosed with schizophrenia. The identification and management of TRS in clinical practice are inconsistent and not evidence based. No established clinically relevant criteria for defining and treating TRS exist, although guidelines have been promulgated for clozapine use among TRS patients. This report summarizes the consensus from a roundtable that focused on defining and identifying TRS, pathways to treatment resistance, current treatments, unmet needs, and disease burden. Nine clinical experts in schizophrenia and TRS participated in a closed meeting on June 23, 2017, sponsored by Lundbeck, at which published literature in key areas of TRS research was reviewed. The findings from published studies were synthesized by experts in each area and presented to the group for review and discussion. It was agreed that inadequate response to 2 different antipsychotics, each taken with adequate dose and duration, is required to establish TRS. This recommendation is consistent with guidelines for clozapine use. For each trial, objective symptom measures should be used to assess treatment response, with medication adherence ensured. Once nonresponse is established (after ≥ 12 weeks for positive symptoms [2 trials of ≥ 6 weeks]), the treatment plan should be reevaluated and alternative pharmacologic or nonpharmacologic treatments considered. With increased awareness, those involved in the care of patients with schizophrenia will be able to identify TRS earlier in its course, thus supporting more informed treatment decisions by clinicians, patients, and caregivers to reduce the overall disease burden. J Clin Psychiatry 2019;80(2):18com12123 To cite: Kane JM, Agid O, Baldwin ML, et al. Clinical guidance on the identification and management of treatment-resistant schizophrenia.

Studies of the effectiveness of medical and vocational rehabilitation and the disincentive effects of workers' compensation benefits frequently assume that a return to work signals the end of the limiting effects of injuries. This study is the first to test that assumption empirically. The authors use a rich data set on Ontario workers with permanent partial impairments resulting from injuries that occurred between 1974 and 1987 to show that the effects of injuries on employment are more enduring than previous studies indicate. The rate of successful returns to employment, measured by first return to work, is 85%, but the rate of success evaluated over a longer time period is only 50%.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. University of Wisconsin Press and The Board of Regents of the University of WisconsinSystem are collaborating with JSTOR to digitize, preserve and extend access to The Journal of Human Resources. ABSTRACTThe 1984 panel of the Survey of Income and Program Participation is used to estimate the extent of labor market discrimination against men with disabilities. Men with disabilities are classified into a group with impairments that are subject to prejudice (handicapped) and a group with impairments that are less subject to prejudice (disabled). Very large differences in employment rates and hourly wages are found between handicapped and nondisabled men. The employment rates and hourly wages of disabled men are slightly lower than those of nondisabled men but substantially higher than those of handicapped men. Using data from the 1972 Social Security Survey of the Disabled as a benchmark, we find that wage differentials between nondisabled and both disabled and handicapped men increased between 1972 and 1984. The employment rate for handicapped men also increased but the 1984 rate was still substantially lower than the rates for nondisabled or disabled men.

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A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.