
Research view
Title: | Schizophrenia resistance: is there a difference? |
Author: | Mamdoh ElGamal, Maha ElTayebani and Seham Fathi |
Abstract: |
Background
Schizophrenia is a chronic disease of the body and mind that affects 1% of the
population. About one-fifth to one-third of all patients with schizophrenia do not
respond adequately to drug treatment and that have been consistent over time.
Definitions of this group have long been hampered by a lack of consistency with
confusion with chronicity. Clozapine has shown superior efficacy and this has been
replicated consistently.
Aim and objectives
Because of the high prevalence, importance, and inconsistency of schizophrenia
resistance, the current study aimed to (a) examine the differences between resistant
and nonresistant schizophrenic groups in chronic long-stay patients, (b) study the
clinical profile of the clozapine-resistant group in comparison with others, and finally
(c) determine the predictors of resistant schizophrenia.
Methods
This was a retrospective and cross-sectional study of 95 patients with chronic
schizophrenia or schizoaffective disorder, admitted in long-stay hospital wards at the
Psychological Medicine Hospital (Kuwait). They were interviewed by Structured
Clinical Interview for DSM-IV and diagnosed according to the Diagnostic and
Statistical Manual of Mental Illness, 4th ed. criteria. Patients were assessed by the
Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale
(PANSS), Clinical Global Impression Severity (CGIS) scale, and Mini-Mental State
Examination. Sociodemographics, clinical characteristics, and the history of treatment
were determined. Schizophrenia resistance was formulated according to modified
Kane’s criteria, which include the following: BPRS score of at least 45; two or more of
positive symptoms score of at least 4 (suspiciousness, hallucinatory behavior,
conceptual disorganization, and unusual thoughts); CGIS score of at least 4
(moderate to extremely ill); previous failure on two antipsychotic trials of different
categories of the full therapeutic range (Z1000 mg of chlorpromazine equivalent) and
for at least 3–6 months’ duration; and finally, no preceding good function for at least
2.5 years in the last 5 years.
Results
Thirty-six patients fulfilled the criteria of schizophrenia resistance (37.8%). There was a
significant shift in the drug regimen prescribed, with the prescription of more atypical
antipsychotics, especially clozapine, with repeated failure of previous drug trials. The
only significant difference between the resistant and the nonresistant group was in the
psychopathological severity, indicated by higher scores on PANSS, and CGIS scores.
Age younger than 40 years and early onset age of schizophrenia (o20 years) were
powerful predictors for schizophrenia resistance; other sociodemographic and clinical
characteristics lacked significant predictive value.
Conclusion and recommendation
Younger age and early-onset schizophrenia are considered poor prognostic factors.
Early aggressive management of schizophrenia may help eliminate chronicity as well as
resistance. Research on the biological predisposition for schizophrenia resistance
including the clozapine resistance group is required.
Keywords:
clozapine, resistance to antipsychotics, schizophrenia
|
Journal: | Egyptian Journal of Psychiatry 2013, 34:51–60 |
Text: | |
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