Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.
Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology.
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DOI：
10.1176/appi.ajp.2016.16050503
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发表时间：
2017-03-01
期刊：
影响因子：
--
通讯作者：
Correll CU
中科院分区：
文献类型：
--
作者：
Howes OD;McCutcheon R;Agid O;de Bartolomeis A;van Beveren NJ;Birnbaum ML;Bloomfield MA;Bressan RA;Buchanan RW;Carpenter WT;Castle DJ;Citrome L;Daskalakis ZJ;Davidson M;Drake RJ;Dursun S;Ebdrup BH;Elkis H;Falkai P;Fleischacker WW;Gadelha A;Gaughran F;Glenthøj BY;Graff-Guerrero A;Hallak JE;Honer WG;Kennedy J;Kinon BJ;Lawrie SM;Lee J;Leweke FM;MacCabe JH;McNabb CB;Meltzer H;Möller HJ;Nakajima S;Pantelis C;Reis Marques T;Remington G;Rossell SL;Russell BR;Siu CO;Suzuki T;Sommer IE;Taylor D;Thomas N;Üçok A;Umbricht D;Walters JT;Kane J;Correll CU
治疗耐药性使精神分裂症的治疗复杂化。不一致的定义限制了研究和临床翻译。为了解决这个问题，我们评估了当前的方法，然后制定了共识标准和指导方针。对治疗难治性精神分裂症的随机抗精神病药物临床试验进行了系统回顾。提取了耐药定义。随后，由研究人员和临床医生组成的工作组通过i)多阶段混合方法方法制定了共识可操作标准；Ii)通过在线调查确定关键标准；三是召开会议达成共识。42项研究符合纳入标准。其中，21项（50%）研究没有提供可操作的标准，而在其他研究中，标准差异很大，特别是在症状严重程度、既往治疗持续时间和抗精神病药物剂量阈值方面。重要的是无法比较结果，只有两个（5%）研究使用了相同的标准。协商一致小组确定了最低和最佳标准，采用以下原则：1)由标准化评定量表确定的最短持续时间和严重程度的当前症状；2)≥中度功能障碍；3)既往治疗包括≥2种不同的抗精神病药物试验，每种试验的最小持续时间和剂量；4)系统评估的依从性并满足最低标准；5)理想情况下至少有一项前瞻性治疗试验；6)明确区分反应性患者和耐药患者的标准。目前界定精神分裂症治疗耐药性的方法有相当大的差异。我们提出了一致的指导方针，为精神分裂症的治疗耐药性、适当治疗和治疗反应的确定和报告提供了操作标准，为研究和临床转化提供了基准。
Treatment resistance complicates the management of schizophrenia. Research and clinical translation is limited by inconsistent definitions. To address this we evaluated current approaches and then developed consensus criteria and guidelines. A systematic review of randomized antipsychotic clinical trials in treatment resistant schizophrenia was performed. Definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed by a working group of researchers and clinicians through i) a multi-phase, mixed methods approach; ii) identifying key criteria via an online survey; and iii) meetings to achieve consensus. 42 studies met inclusion criteria. Of these, 21 (50%) studies did not provide operationalized criteria, whilst in others, criteria varied considerably, particularly regarding symptom severity, prior treatment duration and antipsychotic dose thresholds. Important for the inability to compare results, only two (5%) studies utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) ≥moderate functional impairment; 3) prior treatment consisting of ≥2 different antipsychotic trials, each for a minimum duration and dose; 4) adherence systematically assessed and meeting minimum criteria; 5) ideally at least one prospective treatment trial; 6) criteria that clearly separated responsive from treatment resistant patients. There is considerable variation in current approaches to defining treatment resistance in schizophrenia. We present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment and treatment response in schizophrenia, providing a benchmark for research and clinical translation.
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影响因子：
2.9
作者：
Emsley, Robin;Oosthuizen, Petrus;Martinez, Lupe
通讯作者：
Martinez, Lupe
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