Is treatment-resistant schizophrenia categorically distinct from treatment-responsive schizophrenia? a systematic review

摘要: Schizophrenia is a highly heterogeneous disorder, and around third of patients are treatment-resistant. The only evidence-based treatment for these clozapine, an atypical antipsychotic with relatively weak dopamine antagonism. It plausible that varying degrees response to antipsychotics reflect categorically distinct illness subtypes, which would have significant implications research clinical practice. If subtypes could be distinguished at onset, this represent first step towards personalised medicine in psychiatry. This systematic review investigates whether current evidence supports conceptualising treatment-resistant treatment-responsive schizophrenoa as subtypes. A literature search was conducted, using PubMed, EMBASE, PsycInfo, CINAHL OpenGrey databases, identify all studies compared schizophrenia (defined either lack two trials or clozapine prescription) known non-clozapine antipsychotics). Nineteen moderate quality met inclusion criteria. most robust findings indicate show glutamatergic abnormalities, dopaminergic decreases grey matter patients. Treatment-resistant were also reported higher familial loading; however, no individual gene-association study their surviving correction multiple comparisons. Tentative different subtype schizophrenia. However, limited confirmation will require replication rigorously controlled large sample sizes prospective designs.