<p>Exploration of Treatment-Resistant Schizophrenia Subtypes Based on a Survey of 204 US Psychiatrists</p>

Abstract

ObjectiveTo explore and describe potential subgroups within the treatment-resistant schizophrenia (TRS) population, using data from a survey of US psychiatrists.MethodsPsychiatrists completed an online survey of demographic/clinical characteristics and treatment history for two of their patients with TRS. Patients were stratified according to number of suicide attempts, number of hospitalizations, employment status, and TRS onset time frame.ResultsOf the 408 patients with TRS described by psychiatrists, 37.5% had ≥1 suicide attempt, 78.9% had ≥2 hospitalizations, 74.5% were unemployed, 45.0% had TRS onset within 5 years of first treatment (a further 8.0% had TRS from first treatment), and 31.5% had TRS onset after 5 years (15.5% unknown). Patients with ≥1 (vs 0) suicide attempts had statistically significantly more psychiatric (3.6 vs 2.2) and physical (2.2 vs 1.6) comorbidities. Patients with ≥2 (vs ≤1) hospitalizations were statistically significantly more likely to have hallucinations, conceptual disorganization, social withdrawal, and cognitive dysfunction, and had more psychiatric (3.0 vs 1.9) and physical (2.0 vs 1.1) comorbidities. Unemployed (vs employed) patients were statistically significantly more likely to have delusions, hallucinations, blunted affect, social withdrawal, and cognitive dysfunction, and had more psychiatric (2.9 vs 2.3) and physical (2.1 vs 1.2) comorbidities. Patients with TRS onset ≤5 (vs >5) years were statistically significantly younger (35.0 vs 43.7 years), less likely to have hallucinations and social withdrawal, and had fewer psychiatric (2.6 vs 3.3) and physical (1.7 vs 2.3) comorbidities.ConclusionsGreater clinical burden in TRS is associated with greater illness severity and chronicity markers, suggesting a dimensional gradient from non-TRS to mild–moderate and more severe forms of TRS. Time to onset of TRS may have implications for outcomes, with data indicating greater burden in those with late-onset TRS. Accumulation of illness over time may be more important than time to onset.

Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile

“…Also, these data do not differ from previous report on the medical profile for TRS patients. 52 , 53 We found a mean clozapine dose of 266 mg/day (SD ±135), and our outcomes are consistent with other reports. 54 , 55 Thus, although our sample is small, it appears to be representative of the TRS population reported in the literature.…”

Pathway-Phenotypes of Non-responders and Partial Responders to Treatment With Antipsychotics in Schizophrenia: A Machine Learning Study

“…These findings extend those of a previous study reporting that cognitive deficits are more deficient in NRTT than in PRTT and are associated with clinical symptoms (32). This greater neurocognitive burden in TRS associated with greater illness severity suggests that there is a continuum or dimensional gradient from non-TRS to mild-TRS and the more severe forms of TRS (33). Nevertheless, some other studies attempted to define TRS as a qualitatively different class as in a systemic review of 19 studies which concluded that based on biomarker research including glutamatergic, but no dopaminergic aberrations, reduced grey matter and a higher familial load there is tentative evidence to conceptualize TRS as a qualitatively different class to non-TRS (34).…”

Clinical correlates of early onset antipsychotic treatment resistance

“…There is one main difference between our study and previous research on early/late TRS (Ajnakina et al, 2020;Correll et al, 2019;Demjaha et al, 2017;Lally et al, 2016). Previous studies focused on investigating predictors of early, or late, onset of TRS compared to the non-development of TRS; while our study focused exclusively on exploring if there are sociodemographic and clinical factors related to the length of treatment in a cohort of cases of TRS.…”