Refractory Schizophrenia


An estimated 30% of people with schizophrenia have refractory schizophrenia, which means their positive schizophrenia symptoms have proven resistant even to adequate treatment with antipsychotic drugs. Most guidelines indicate that two or three treatments with typical or atypical antipsychotic drugs be unsuccessful before a patient's schizophrenia is considered refractory. While this sounds like an easy guideline to follow, it is sometimes difficult to tell whether the patient's schizophrenia is treatment-resistant, or the patient themselves is resisting treatment by not complying with the treatment regimen.

There is currently only one medication consistently shown to be effective in treating refractory schizophrenia. This medication, clozapine, is an atypical antipsychotic that has been the standard treatment for refractory schizophrenia for many years. Other medications, namely risperidone and olanzapine, have been considered as options for treating refractory schizophrenia, but their effectiveness remains unclear.

Unfortunately, a recent study indicates that clozapine is not being prescribed as widely as it could be, with only 2%-3% of people with schizophrenia taking the drug (compared to the estimated 30% who suffer from treatment-resistant schizophrenia). This suggests that many patients with refractory schizophrenia are not receiving the treatment most likely to succeed in lessening their symptoms.