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Ingrid Melle, Isabel Kreis, Kristin Fjelnseth Wold
University of Oslo, Norway
Background: Approximately ¼ of patients with first-episode psychosis do not respond well to standard antipsychotics and are considered treatment-resistant (TR). Patients with treatment resistance have more frequent and severe symptoms, more comorbidities, and are more hospitalized. Approximately ½ of TR patients respond to clozapine, and most guidelines recommend the use of clozapine after two unsuccessful trials of standard antipsychotics. The use of clozapine is, however, often delayed, and an unknown number do not receive any offers to try it at all.
Material and methods: A group of 102 patients with a first episode of schizophrenia spectrum psychosis were recruited during their first treatment, underwent a comprehensive assessment battery at baseline, and were followed up after ten years of treatment.
Results: A total of 28% met the criteria for clinical recovery, 32% met the criteria for treatment resistance, and 40% did not meet either of these criteria (“middle group”). Of the latter group, 11 had at least moderately severe symptoms and dysfunction corresponding to the clinical criteria for TR but had not received two adequate trials of antipsychotics and did thus not meet the full criteria for TR. In addition, only seven patients in the TR group had received a trial of clozapine.
Conclusion: This means that ½ of the poor outcome patients had not received treatment as recommended by current guidelines.
