Fatores de risco associados à esquizofrenia resistente ao tratamento em primeiro episódio psicótico

Abstract

Objective: The risk factors for treatment-resistant schizophrenia (TRS) in first-episode psychosis (FEP) remain unclear. The aim of this study was to investigate risk indicators for TRS in FEP. Methods: A total of 53 patients with FEP and a diagnosis of schizophrenia were selected among individuals seen at the psychiatric ward of Hospital das Clinicas Luzia de Pinho Melo between 2011 and 2015. Upon admission, subjects were evaluated with the Positive and Negative Syndrome Scale (PANSS) and received initial treatment for 4 weeks. Patients showing < 40% reduction on PANSS in response to antipsychotic treatment had the drug changed, and the scales were applied again after 4 weeks. After failure with two antipsychotics, at full doses, for 4 weeks each, clozapine was introduced, and the patient was considered to have TRS. Logistic regression was performed including gender, age at onset, duration of untreated psychosis, substance use, global assessment of functioning at baseline and totalPANSS at baseline as independent variables, and TRS as the dependent variable. Results: Duration of untreated psychosis presented significance at p = 0.038 and Exp (B) = 4.29; for total PANSS, results were p = 0.012 and Exp (B) = 1.06. Conclusion: Identifying factors associated with early resistance to treatment could allow clinicians to avoid delays in the introduction of clozapine and prevent worse prognosis for these patients.