Abstract
BackgroundApproximately one-third of schizophrenia patients eventually develop treatment-resistant schizophrenia (TRS). Although the time course of TRS development varies from patient to patient, the details of these variations have not been clarified. The present study compared the duration of time required to achieve control of the first-episode psychosis (FEP) between patients who went on to develop TRS and those who did not, in order to determine whether a bifurcation point exists for the transition to TRS.MethodsThe present study included 271 schizophrenia patients. Based on the clinical assessment, each patient was assigned to a TRS (n = 79) or Non-TRS group (n = 182). Clinical factors relating to FEP treatment such as the duration of initial hospital admission and the degree of improvement were retrospectively identified.ResultsThere was no significant difference in the duration of initial hospital admission (defined as the time from treatment introduction to successful discharge) between the two groups (mean of 87.9 days for TRS vs. 53.3 days for Non-TRS). The degree of improvement during initial hospital admission of the TRS group was significantly lower than that of the Non-TRS group (Global Assessment of Functioning (GAF) of 50 points for TRS vs. 61 points for Non-TRS). Approximately half of the TRS patients showed an acute onset pattern and longer hospital admission (mean 169 days) for their FEP. The other half of TRS patients needed no hospital admission, indicating an insidious onset pattern with no clear psychotic episode and treatment introduction without hospital admission.ConclusionsFuture TRS patients can have difficulty in improvement during their FEP. There appear to be two distinct patterns for the development of TRS. One pattern is characterized by refractory positive symptoms and a longer period to control the first psychosis; the other shows latent or insidious onset and poor response to the initial treatment.
Highlights
One-third of schizophrenia patients eventually develop treatment-resistant schizophrenia (TRS)
We compared the duration of initial hospital admission, which we defined as the period from treatment introduction to successful discharge, among subjects with and without current TRS
Duration of initial hospital admission The duration of initial hospital admission-the time from treatment introduction until successful discharge- was longer in the TRS group than in the Non-TRS group, but the difference
Summary
One-third of schizophrenia patients eventually develop treatment-resistant schizophrenia (TRS). It has been estimated that about 30–40% of all patients eventually fulfill the criteria of TRS [5, 6] These data suggest that among patients eventually classified as having TRS, a few demonstrate TRS at an early treatment phase while the rest transit into TRS at various later time-points during their disease course. Younger onset, higher initial negative symptoms and longer duration of untreated psychosis (DUP) have been proposed as factors predictive of transition to TRS [8]. Despite these findings, the detailed process of development to TRS remains to be elucidated. We compared the duration of initial hospital admission, which we defined as the period from treatment introduction to successful discharge (with successful discharge defined as a subsequent 3 months of successful treatment in an outpatient clinic), among subjects with and without current TRS
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