Robert R. Conley
University of Maryland School of Medicine
and Maryland Psychiatric Research Center
A systematic approach to the evaluation and characterization of patients refractory to treatment with conventional antipsychotic drugs has become increasingly important since the introduction of clozapine, risperidone, and olanzapine. The need for accurate evaluation will increase further with the introduction of other new-generation antipsychotic medications. People with schizophrenia may manifest a poor response to drug therapy secondary to intolerance of medication, poor compliance, or inappropriate dosing. In addition, the nature of some patients' illness may account for their resistance to antipsychotic drug therapy. As clinicians face the decision of when to change from one antipsychotic to another, a clear understanding of the appropriate length of a trial and of what target symptoms should respond to antipsychotics is critical for maximizing response in patients with refractory symptoms.
One-fifth to one-third of all patients with schizophrenia have significant refractory symptoms. This finding has been consistent over time ( 1 - 3). Treatment of patients in this group has remained a persistent public health problem. These patients are highly symptomatic and require extensive periods of hospital care ( 4), and their care comprises