~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

RESEARCH WEEKLY: An Integrated View into Treatment Resistant Schizophrenia
A number of people with schizophrenia do not respond to any antipsychotic medication,
a condition known as treatment resistance. The exact percentage is unknown since
definitions of treatment resistant schizophrenia (TRS) vary widely and people respond
differently to antipsychotic medications. It is estimated that approximately 30%
of patients with schizophrenia do not respond to dopamine-blocking antipsychotics
and of those, only half find symptom relief by the only alternative medication,
clozapine. As a result, those with TRS typically experience poorer clinical outcomes.
However, recent research is beginning to unravel the biological basis for non-response
and may assist in the development of effective medications for this population.
The International Treatment Response and Resistance in Psychosis (TRRIP) working
group was convened to provide an operational definition of treatment resistance
that could be used across research and clinical settings. According to a consensus
of the group, the following must occur in order for an individual to be identified
as treatment resistant:


1. Adequate trial of antipsychotic medication in terms of dosage
2. Trial of two antipsychotics for a duration of 6 weeks or longer at a therapeutic
dose
3. Adherence to medication ≥80% confirmed by plasma levels of medication
4. Structured clinical assessments to measure symptom presence and severity
There are differing opinions as to whether the clinical course of TRS is a stable,
specific type of schizophrenia or the result of a neurodegenerative process of the
illness. However, a recent longitudinal (10 years) study of first episode psychosis
found that the vast majority (80%) of treatment resistant patients were resistant
from the early presentation of their illness. Predictors of TRS include a younger
age of onset, longer duration of untreated psychosis, and prominent negative symptoms
such as blunted affect or social isolation.
Evidence from TRS imaging and genetic studies point to dysregulation of several
neurotransmitters including dopamine and glutamate. In addition, brain imaging demonstrates
increased cortical atrophy in treatment non-responders compared with responders.
While clozapine is the only antipsychotic to show symptom reduction in patients
with TRS and earlier initiation of clozapine is shown to improve outcomes in this
population it is significantly underutilized by clinicians. For the approximately
50% of treatment resistant patients who do not respond to clozapine (ultra-treatment
resistant), unfortunately there are limited efficacious treatment strategies. More
research is needed to understand treatment resistance in schizophrenia and develop
new strategies to improve symptoms for this population.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amy J. Lukes
Project Manager
Treatment Advocacy Center
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

References:

*

Leung, C. C.-Y., et al. (2019). Clinical Course, Neurobiology and Therapeutic Approaches
to Treatment Resistant Schizophrenia. Toward an Integrated View. [[link removed]]
Frontiers in Psychiatry.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Questions? Contact us at [email protected] [mailto:[email protected]]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Research Weekly is a summary published as a public service of the Treatment Advocacy
Center and does not necessarily reflect the findings or positions of the organization
or its staff. Full access to research summarized may require a fee or paid subscription
to the publications.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical
companies.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

DONATE TODAY [[link removed]]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Gray [[link removed]]

STAY CONNECTED:

Like us on Facebook [[link removed]]

Follow us on Twitter [[link removed]]

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Forward this email
[link removed]

This email was sent to [email protected] by [email protected].

Update Profile/Email Address
[link removed]


Instant removal with SafeUnsubscribe(TM)
[link removed]


Privacy Policy:
[link removed]

Online Marketing by
[link removed]
[link removed]



Treatment Advocacy Center | 200 N Glebe Rd | Ste 801 | Arlington | VA | 22203