Howes, O. D., McCutcheon, R., Agid, O., de Bartolomeis, A., van Beveren, N. J. M., Birnbaum, M. L., Bloomfield, M. A. P., Bressan, R. A., Buchanan, R. W., Carpenter, W. T., Castle, D. J., Citrome, L., Daskalakis, Z. J., Davidson, M., Drake, R. J., Dursun, S., Ebdrup, B. H., Elkis, H., Falkai, P., ... Kane, J. (2017). Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. The American Journal of Psychiatry, 174(3), 216-229. https://doi.org/10.1176/appi.ajp.2016.16050503
Howes, OD, McCutcheon, R, Agid, O, de Bartolomeis, A, van Beveren, NJM, Birnbaum, ML, Bloomfield, MAP, Bressan, RA, Buchanan, RW, Carpenter, WT, Castle, DJ, Citrome, L, Daskalakis, ZJ, Davidson, M, Drake, RJ, Dursun, S, Ebdrup, BH, Elkis, H, Falkai, P, Fleischacker, WW, Gadelha, A, Gaughran, F, Glenthøj, BY, Graff-Guerrero, A, Hallak, JEC, Honer, WG, Kennedy, J, Kinon, BJ, Lawrie, SM, Lee, J, Leweke, FM, MacCabe, JH, McNabb, CB, Meltzer, H, Möller, H-J, Nakajima, S, Pantelis, C, Reis Marques, T, Remington, G, Rossell, SL, Russell, BR, Siu, CO, Suzuki, T, Sommer, IE, Taylor, D, Thomas, N, Üçok, A, Umbricht, D, Walters, JTR & Kane, J 2017, 'Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology', The American Journal of Psychiatry, vol. 174, no. 3, pp. 216-229. https://doi.org/10.1176/appi.ajp.2016.16050503
@article{7336b3d72c4240578ea7658ac65c315f,
title = "Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology",
abstract = "OBJECTIVE: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.METHOD: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.RESULTS: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.CONCLUSIONS: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.",
keywords = "Antipsychotic Agents/therapeutic use, Brief Psychiatric Rating Scale/statistics & numerical data, Drug Resistance, Humans, Practice Guidelines as Topic, Psychometrics, Randomized Controlled Trials as Topic, Schizophrenia/diagnosis, Schizophrenic Psychology",
author = "Howes, {Oliver D} and Rob McCutcheon and Ofer Agid and {de Bartolomeis}, Andrea and {van Beveren}, {Nico J M} and Birnbaum, {Michael L} and Bloomfield, {Michael A P} and Bressan, {Rodrigo A} and Buchanan, {Robert W} and Carpenter, {William T} and Castle, {David J} and Leslie Citrome and Daskalakis, {Zafiris J} and Michael Davidson and Drake, {Richard J} and Serdar Dursun and Ebdrup, {Bj{\o}rn H} and Helio Elkis and Peter Falkai and Fleischacker, {W Wolfgang} and Ary Gadelha and Fiona Gaughran and Glenth{\o}j, {Birte Y} and Ariel Graff-Guerrero and Hallak, {Jaime E C} and Honer, {William G} and James Kennedy and Kinon, {Bruce J} and Lawrie, {Stephen M} and Jimmy Lee and Leweke, {F Markus} and MacCabe, {James H} and McNabb, {Carolyn B} and Herbert Meltzer and Hans-J{\"u}rgen M{\"o}ller and Shinchiro Nakajima and Christos Pantelis and {Reis Marques}, Tiago and Gary Remington and Rossell, {Susan L} and Russell, {Bruce R} and Siu, {Cynthia O} and Takefumi Suzuki and Sommer, {Iris E} and David Taylor and Neil Thomas and Alp {\"U}{\c c}ok and Daniel Umbricht and Walters, {James T R} and John Kane",
year = "2017",
month = mar,
day = "1",
doi = "10.1176/appi.ajp.2016.16050503",
language = "English",
volume = "174",
pages = "216--229",
journal = "The American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Publishing, Inc.",
number = "3",
}
TY - JOUR
T1 - Treatment-Resistant Schizophrenia
T2 - Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology
AU - Howes, Oliver D
AU - McCutcheon, Rob
AU - Agid, Ofer
AU - de Bartolomeis, Andrea
AU - van Beveren, Nico J M
AU - Birnbaum, Michael L
AU - Bloomfield, Michael A P
AU - Bressan, Rodrigo A
AU - Buchanan, Robert W
AU - Carpenter, William T
AU - Castle, David J
AU - Citrome, Leslie
AU - Daskalakis, Zafiris J
AU - Davidson, Michael
AU - Drake, Richard J
AU - Dursun, Serdar
AU - Ebdrup, Bjørn H
AU - Elkis, Helio
AU - Falkai, Peter
AU - Fleischacker, W Wolfgang
AU - Gadelha, Ary
AU - Gaughran, Fiona
AU - Glenthøj, Birte Y
AU - Graff-Guerrero, Ariel
AU - Hallak, Jaime E C
AU - Honer, William G
AU - Kennedy, James
AU - Kinon, Bruce J
AU - Lawrie, Stephen M
AU - Lee, Jimmy
AU - Leweke, F Markus
AU - MacCabe, James H
AU - McNabb, Carolyn B
AU - Meltzer, Herbert
AU - Möller, Hans-Jürgen
AU - Nakajima, Shinchiro
AU - Pantelis, Christos
AU - Reis Marques, Tiago
AU - Remington, Gary
AU - Rossell, Susan L
AU - Russell, Bruce R
AU - Siu, Cynthia O
AU - Suzuki, Takefumi
AU - Sommer, Iris E
AU - Taylor, David
AU - Thomas, Neil
AU - Üçok, Alp
AU - Umbricht, Daniel
AU - Walters, James T R
AU - Kane, John
PY - 2017/3/1
Y1 - 2017/3/1
N2 - OBJECTIVE: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.METHOD: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.RESULTS: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.CONCLUSIONS: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
AB - OBJECTIVE: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.METHOD: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.RESULTS: Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.CONCLUSIONS: There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
KW - Antipsychotic Agents/therapeutic use
KW - Brief Psychiatric Rating Scale/statistics & numerical data
KW - Drug Resistance
KW - Humans
KW - Practice Guidelines as Topic
KW - Psychometrics
KW - Randomized Controlled Trials as Topic
KW - Schizophrenia/diagnosis
KW - Schizophrenic Psychology
U2 - 10.1176/appi.ajp.2016.16050503
DO - 10.1176/appi.ajp.2016.16050503
M3 - Review
C2 - 27919182
SN - 0002-953X
VL - 174
SP - 216
EP - 229
JO - The American Journal of Psychiatry
JF - The American Journal of Psychiatry
IS - 3
ER -