Background Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias. Aims We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access. Method We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies. Results Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1–27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5–30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11–2.21, P = 0.010). Conclusions Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.

BACKGROUND Many clinicians have used glycolic acid (GA) peels for facial acne, scarring, and hyperpigmentation, mainly in lighter skin types. Salicylic-mandelic acid combination peels (SMPs) are a newer modality, and there have been no well-controlled studies comparing them with other conventional agents.

We report momentum-resolved charge excitations in a one-dimensional (1D) Mott insulator studied using high resolution inelastic x-ray scattering over the entire Brillouin zone for the first time. Excitations at the insulating gap edge are found to be highly dispersive (momentum dependent) compared to excitations observed in two-dimensional Mott insulators. The observed dispersion in 1D cuprates ( SrCuO2 and Sr2CuO3) is consistent with charge excitations involving holons which is unique to spin-1/2 quantum chain systems. These results point to the potential utility of momentum-resolved inelastic x-ray scattering in providing valuable information about electronic structure of strongly correlated insulators.

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