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What do we know about treatment-resistant schizophrenia? – A systematic review

Published online by Cambridge University Press:  23 March 2020

A. Seppälä ,
J. Miettunen ,
N. Hirvonen ,
M. Isohanni ,
J. Moilanen ,
H. Koponen ,
J. Seppälä  and
E. Jääskeläinen
A. Seppälä*
Affiliation:
University of Oulu, Center for Life-Course Epidemiology and Systems Medicine, Oulu, Finland
J. Miettunen
Affiliation:
University of Oulu, Center for Life-Course Epidemiology and Systems Medicine, Oulu, Finland
N. Hirvonen
Affiliation:
University of Oulu, Information Studies, Faculty of Humanities, Oulu, Finland
M. Isohanni
Affiliation:
University of Oulu and Oulu University Hospital, Research Unit of Clinical Neuroscience, Department of Psychiatry, Oulu, Finland
J. Moilanen
Affiliation:
University of Oulu and Oulu University Hospital, Research Unit of Clinical Neuroscience, Department of Psychiatry, Oulu, Finland
H. Koponen
Affiliation:
University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
J. Seppälä
Affiliation:
South-Savo Hospital District, Department of Psychiatry, Mikkeli, Finland
E. Jääskeläinen
Affiliation:
University of Oulu, Center for Life-Course Epidemiology and Systems Medicine, Oulu, Finland
*
*Corresponding author.

Abstract

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Introduction

Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia. From one fifth to one third of all patients with schizophrenia are resistant to treatment.

Objective

To determine the knowledge on TRS and to find out the extent and the quality of research on TRS.

Aims

To conduct a systematic review of the current literature on TRS.

Methods

Original studies and reviews on TRS were systematically collected from PubMed and Scopus databases. The following search strategy was used as a title search; (“ultra-resistant” OR “treatment-refractory” OR “treatment-resistant”) AND (schizophrenia). The search was restricted to English language articles.

Results

The literature search identified 403 studies. After abstract and title review, 324 studies were included. The included studies considered medication (n 213), electroconvulsive therapy and repetitive transcranial magnetic stimulation (15), prognosis (15), genetics (15), studies on neurobiology (15), definitions (14), psychotherapy (12), brain structures and functioning (10), cognition (7) and other miscellaneous studies (6) on TRS. Definitions of TRS varied notably and in most of the non-pharmacological studies, the samples were fairly small. Regarding treatments, clozapine, ECT, and cognitive-behavioral therapy have shown effectiveness, though the quality of research on interventions is limited. Very little is known about risk factors and predictors of outcome in TRS.

Conclusions

Our findings suggest TRS is poorly studied and understood condition contrasted to its high prevalence, clinical importance and poor prognosis. There is a lack of studies on epidemiology, for example risk factors of TRS, as well as on outcomes and longitudinal course. Most of the studies considered medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EV1190
Information
European Psychiatry , Volume 33 , Issue S1: Abstracts of the 24th European Congress of Psychiatry , March 2016 , pp. S586
Copyright
Copyright © European Psychiatric Association 2016
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