Please use this identifier to cite or link to this item: https://repositorio.unifesp.br/handle/11600/55083
Title: Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology
Authors: Howes, Oliver D.
McCutcheon, Rob
Agid, Ofer
de Bartolomeis, Andrea
van Beveren, Nico J. M.
Birnbaum, Michael L.
Bloomfield, Michael A. P.
Bressan, Rodrigo A. [UNIFESP]
Buchanan, Robert W.
Carpenter, William T.
Castle, David J.
Citrome, Leslie
Daskalakis, Zafiris J.
Davidson, Michael
Drake, Richard J.
Dursun, Serdar
Ebdrup, Bjorn H.
Elkis, Helio
Falkai, Peter
Fleischacker, W. Wolfgang
Gadelha, Ary
Gaughran, Fiona
Glenthoj, Birte Y.
Graff-Guerrero, Ariel
Hallak, Jaime E. C.
Honer, William G.
Kennedy, James
Kinon, Bruce J.
Lawrie, Stephen M.
Lee, Jimmy
Leweke, F. Markus
MacCabe, James H.
McNabb, Carolyn B.
Meltzer, Herbert
Moeller, Hans-Juergen
Nakajima, Shinchiro
Pantelis, Christos
Marques, Tiago Reis
Remington, Gary
Rossell, Susan L.
Russell, Bruce R.
Siu, Cynthia O.
Suzuki, Takefumi
Sommer, Iris E.
Taylor, David
Thomas, Neil
Ucok, Alp
Umbricht, Daniel
Walters, James T. R.
Kane, John
Correll, Christoph U.
Issue Date: 2017
Publisher: Amer Psychiatric Publishing, Inc
Citation: American Journal Of Psychiatry. Washington, v. 174, n. 3, p. 216-229, 2017.
Abstract: Objective: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. Method: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus. Results: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds
only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale
2) moderate or worse functional impairment
3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage
4) systematic monitoring of adherence and meeting ofminimumadherence criteria
5) ideally at least one prospective treatment trial
and 6) criteria that clearly separate responsive from treatment-resistant patients. Conclusions: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
URI: https://repositorio.unifesp.br/handle/11600/55083
ISSN: 0002-953X
Other Identifiers: http://dx.doi.org/10.1176/appi.ajp.2016.16050503
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