Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia

CHAMLONG DISAYA VANISH, M.D.*, MANIT SRISURAPANONT, M.D.*, PRIMPRAO DISA Y A VAN ISH, Ph.D.*, PONGSATORN NETRAKOM, M.D.****, SRICHAN PHORNCHIRASILP, Ph.D.******, PAITOON SAMUTHRSINDH, M.D.********, KITTIWAN THIAM-KAEW, M.D.**********, PICHET UDOMRATN, M.D.**, DUANGJAI KASANTIKUL, M.D.***; THIENCHAI NGAMTIPWATTHANA, M.D.*****, POONSRI RANGSEEKAJEE, M.D.*******, PRAMOTE SUKANICH, M.D.*********, TAWEESIN VISANUYOTHIN, M.D.***********

Affiliation : *Department of Psychiatry, Faculty of Medicine. Chiang Mai University, Chiang Mai 50200. **Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90112. ***Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok I 0330. ****Department of Psychiatry and Neurology, Phramongkutklao Hospital and College of Medicine. Bangkok 10400, *****Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700. ******Department of Pharmacology, Faculty of Pharmacy, Mahidol University. Bangkok 10400, *******Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002 ********Srithanya Hospital, Nonthaburi 11000, *********Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital. Mahidol University. Bangkok 10400, **********Suanprung Psychiatric Hospital, Chiang Mai 50200, ***********Somdet Chaopraya Hospital, Bangkok 10600, Thailand. t This project was an academic activity of the Royal College of Psychiatrists of Thailand and supported by a grant from the Health Systems Research Institute (HSRI). t The views and recommendations in this guideline are those of the working group and do not retlect the position of those two organizations.

AbstractThe authors proposed to develop an evidence-based guideline relevant to drug use for treat- ment-resistant schizophrenia (TRS), which will be called "Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia or PTRS Guideline". The authors performed a MEDLINE search (between 1966 and December 1998) and classified the study designs of those trials by using the system proposed by the Agency for Health Care Policy and Research (AHCPR). The levels of evidence were graded and recommendations were made by the use of a system modified from that of the AHCPR. One hundred and sixty-three articles met the inclusion criteria for the review. For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class. A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. ~c:Iozapi!Je should be considered as a first-line treatment for TRS. Risperidone should be considered in a TRS patient who refuses to have regular blood monitoringor has -contraindication for clozapine. Physicians should use this guideline to accompany others that suggest the overview of treatment for schizophrenia. Appro- priate application and the limitations of the guideline are also discussed.

Keywords : Treatment Resistant Schizophrenia, Pharmacotherapy, Guideline

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