Treatment resistance in schizophrenia

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7027.325 (Published 10 February 1996) Cite this as: BMJ 1996;312:325
  1. Eve C Johnstone,
  2. Robert Sandler
  1. Professor of psychiatry Lecturer in psychiatry Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH10 5HF

    Alternative drugs may offer clearer understanding of underlying mechanisms Since the 1950s, when chlorpromazine was introduced into psychiatric practice, antipsychotic drugs have been the cornerstone of the management of schizophrenia. They have three main functions: to treat the positive symptoms of acute schizophrenic episodes; to reduce schizophrenic relapse; and to manage the negative features of schizophrenia, although the evidence for their efficacy in this area is weaker. It is in relation to positive symptoms that the term treatment resistance is generally used. While the concept of treatment resistance remains ill defined, recent advances in drug treatment may bring better understanding of its underlying mechanisms.

    It has been evident for many years that some cases of schizophrenia are resistant to treatment. In trials of conventional antipsychotic drugs about 30% of acute cases show only limited improvement1 and about 7% of these patients seem to show no response from the …

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