Therapy resistance in schizophrenic patients - Present status

Therapy resistance in schizophrenic patients constitutes a severe clinical problem. Depending on the underlying definition prevalence ranges from 10 to 30 %. Until the end of the 80s, definitions of therapy resistance were closely associated with the persistence of positive symptoms. Since the middle of the 90s other outcome criteria have been additionally taken into consideration (e.g., negative symptoms and social functioning). The reasons for the failure of neuroleptic treatment are numerous: besides illness-related factors (e.g., negative symptomatology) patients' attitudes (e.g., reduced compliance) and treatment-related issues (e.g., neuroleptic side effects) play a prominent role. Regarding the treatment of these patients two factors are of major importance: (1) Early detection of therapy resistant patients and (2) an adequate psychopharmacotherapy. Prior to the introduction of further atypical neuroleptics, clozapine was considered the "gold standard" for treating these patients. The efficacy of new atypical antipsychotics like risperidone and olanzapine as well as other alternative treatment options (carbamazepine, lithium, benzodiazepines) is yet unclear.