Management of treatment resistant schizophrenia in medium secure care

Abstract

Thirty‐one percent of patients within a male medium secure unit (MMSU) were identified with treatment resistant schizophrenia. Almost half of these patients had not received clozapine treatment at least once during the course of their treatment history. The authors recommend that early identification of these patients and the appropriate use of therapeutic treatments, including clozapine, could lead to better outcomes for patients and significant cost savings for the NHS.

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

“…Peters’ test indicated a small-study effect on TRS prevalence (p = 0.044) ( ), as did visual inspection of the funnel-plot ( ): smaller studies (< 200 participants) (40.9% [95% CI 35.1-46.8], n = 2,568) 26 - 28 , 30 , 31 , 34 , 35 , 39 , 41 , 43 - 47 , 49 , 51 - 53 , 55 - 57 , 59 - 61 , 65 , 66 , 70 had higher TRS prevalence estimates than larger studies (32.8% [95% CI 27.9-37.6], n = 26,822) 7 , 8 , 16 , 25 , 29 , 32 , 33 , 36 - 38 , 40 , 42 , 48 , 50 , 54 , 58 , 62 - 64 , 67 - 69 , 71 (Q = 4.61, p = 0.032).…”

“…In the meta-regression analyses, there were significant associations between higher TRS prevalence, older age (0.0066, p = 0.0436), 7 , 25 - 31 , 33 - 38 , 40 , 42 - 47 , 49 - 51 , 53 , 55 , 56 , 58 - 61 , 65 - 68 , 70 higher percentage of clozapine users (0.0056, p = 0.0003), 25 , 30 , 31 , 33 , 34 , 38 , 39 , 41 , 43 , 45 , 46 , 50 , 54 , 56 , 59 - 61 , 64 - 68 lower Global Assessment of Functioning score (-0.0260, p = 0.0324), 45 , 55 , 60 , 61 and lower total TRRIP score (-0.0143, p = 0.0059), 7 , 8 , 16 , 25 - 71 as well as three specific TRRIP criteria: less fulfillment of current symptom severity threshold (-0.0641, p = 0.00462), 7 , 8 , 16 , 25 - 71 less fulfillment of minimum functional impairment (-0.0439, p = 0.0376), 7 , 8 , 16 , 25 - 71 and time course (-0.0634, p = 0.0326) 7 , 8 , 16 , 25 - 71 ( ).…”

“…Low risk of bias studies found a significantly lower TRS prevalence (28.4%, 95% CI 23.9-33.0) 7 , 16 , 25 , 26 , 32 , 33 , 36 , 38 - 40 , 48 , 50 , 53 , 54 , 57 , 58 , 60 , 62 , 66 , 67 , 69 , 71 than high risk of bias studies (44.35%, 95% CI 38.29-50·50) 8 , 27 - 31 , 34 , 35 , 37 , 41 - 47 , 49 , 51 , 52 , 55 , 56 , 59 , 61 , 63 - 65 , 68 , 70 (Q = 17.1, p < 0.0001). The results for individual scores and subgroup analyses across studies for each criterion and total scores are shown in , respectively.…”

“…Notably, population-based studies, which reported lower TRS prevalences, likely due to non-selected samples, also disproportionately considered antipsychotic switching due to adverse effects as failed trials. This methodological feature may explain the unexpected finding that studies which considered intolerability-related treatment failure as TRS 25 - 27 , 29 , 31 , 34 , 35 , 40 , 41 , 47 , 53 , 57 , 64 , 65 , 69 reported a lower TRS prevalence than those that did not. 7 , 8 , 16 , 28 , 30 , 32 , 33 , 36 - 39 , 42 - 46 , 48 - 52 , 54 - 56 , 58 - 63 , 66 - 68 , 70 , 71 …”

Female filicide perpetrators: challenges facing clinicians and secure services

“…In contrast, many of their peers will be suffering from a treatment-resistant illness. Treatment-resistant schizophrenia, for example, is relatively common in medium secure units, and has been found to be present in as many as one-third of patients with schizophrenia in this setting (Lopes 2014).…”