An observational study of clinical subtypes in treatment-resistant schizophrenia and its relation with cognitive insight

Abstract

Background: Schizophrenia is a chronic disorder, and one-third of patients with schizophrenia can develop treatment resistance. Factors such as male gender, early age of onset, positive family history, and low level of social functioning are associated with refractoriness to treatment. However, very few Indian studies have tried to establish the predictors of outcome for schizophrenia. Aims: The aim of the study was to identify the subtypes of treatment-resistant schizophrenia (TRS) and its relation with sociodemographic profile, illness-related variables, and cognitive insight. Materials and Methods: The study was conducted after permission from the institutional review board. Fifty consecutive patients of TRS (treated with two antipsychotics from different classes with adequate doses for 6 weeks each and currently satisfying the Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision criteria for schizophrenia) were included in the study. Patients were administered a semi-structured questionnaire to obtain details about sociodemographic status, and the Positive and Negative Syndrome Scale was administered to identify the subtypes of schizophrenia. Becks Cognitive Insight Scale was used to assess cognitive insight. Results: Almost half of the sample (46%) belonged to the positive subtype followed by negative subtype. There was a statistically significant difference in the age of onset, educational qualification, and suicidal ideation between the positive and negative subtypes. There was a significant association of cognitive insight between TRS subtypes, and it suggested that patients with positive subtype had poorer insight than those with negative subtype. Conclusions: It is important to identify the subtype of schizophrenia and the risk factors for treatment resistance. Early recognition and intervention with respect to these risk factors can improve the long-term course of TRS.