期刊
AMERICAN JOURNAL OF PSYCHIATRY
卷 174, 期 3, 页码 216-229出版社
AMER PSYCHIATRIC PUBLISHING, INC
DOI: 10.1176/appi.ajp.2016.16050503
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资金
- Medical Research Council (UK) [MC-A656-5QD30]
- Maudsley Charity [666]
- Brain and Behavior Research Foundation
- Wellcome Trust [094849/Z/10/Z]
- National Institute for Health Research Biomedical Research Centre at South London
- Maudsley NHS Foundation Trust and King's College London
- Janssen
- Lundbeck
- Otsuka
- Chiesi
- Roche
- Sunovion
- Takeda
- FAPESP (Sao Paulo Research Foundation)
- CNPq (National Council for Technological and Scientific Development, Brazil)
- AstraZeneca
- Eli Lilly
- Allergen
- Bristol-Myers Squibb
- Hospira
- Janssen-Cilag
- Pfizer
- Organon
- Servier
- Sanofi-Aventis
- Wyeth
- Acadia
- Alexza
- Alkermes
- Allergan
- Avanir
- Boehringer Ingelheim
- Forum
- Genentech
- Jazz
- Merck
- Medivation
- Mylan
- Neurocrine
- Novartis
- Noven
- Reckitt Benckiser
- Reviva
- Shire
- Teva
- Valeant
- Vanda
- Johnson Johnson
- FAPESP
- Lundbeck Foundation
- Central Research Labs
- Dainippon Sumitomo
- Hong Kong Health and Medical Research Grant
- Chinese University of Hong Kong
- Elsevier Japan
- Meiji Seika
- Wiley
- MRC [MR/L011794/1, G0700995, MR/N026063/1, MC_U120097115] Funding Source: UKRI
- Lundbeck Foundation [R246-2016-3237, R155-2013-16337] Funding Source: researchfish
- Medical Research Council [MR/N026063/1, MR/L011794/1, 1116129, MC_U120097115, G0700995] Funding Source: researchfish
- National Institute for Health Research [ACF-2014-18-010, ACF-2014-17-008, CL-2015-18-005] Funding Source: researchfish
- Wellcome Trust [200102/Z/15/Z] Funding Source: researchfish
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 ofminimumadherence 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.
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