Understanding treatment-refractory schizophrenia: Root causes, manifestations, and further details.
Dealing with schizophrenia, especially its treatment-resistant form, can be tough. A person is said to have treatment-resistant schizophrenia if they try at least two different schizophrenia drugs at the recommended dose without noticing any improvement in symptoms.
Statistics show that approximately 34% of individuals with schizophrenia fall under this category. Individuals with treatment-resistant schizophrenia might require alternative medications and treatments like psychotherapy, social worker support, and more.
Improvements in treatment-resistant schizophrenia can occur, but they often need time and trial-and-error.
Discover more about treatment-resistant schizophrenia, including its causes, symptoms, treatment options, and more.
What is treatment-resistant schizophrenia?
Treatment-resistant schizophrenia refers to schizophrenia that does not respond well to first-line schizophrenia medications. Symptoms of this condition usually persist, and in some cases, they may even worsen with medication.
To be diagnosed, a person must have undergone 12 weeks of schizophrenia treatment without improvement, even when taking the medication at the right dosage and as prescribed by a doctor. It's important to note that not taking medication or taking it infrequently does not equate to treatment-resistant schizophrenia; instead, this person is simply not following the prescribed treatment plan.
A significant number of people with schizophrenia fail to see much improvement with treatment.
Causes
Despite its prevalence, researchers still do not know what causes treatment-resistant schizophrenia or how to predict who will respond to treatment.
Several factors, including:
- Brain inflammation: Some researchers believe that neuroinflammation, which involves inflammation in the brain and nervous system, plays a role in schizophrenia. They also suggest that certain types of neuroinflammation make treatment-resistant schizophrenia more likely.
- Schizophrenia subtype: Some researchers believe that treatment-resistant schizophrenia is a schizophrenia subtype, with a different disease progression. This form of the condition might occur due to a dysfunction of the neurotransmitters glutamate and gamma-aminobutyric acid, making dopamine more active in the brain.
- Dopamine sensitivity: Another theory suggests that dopamine sensitivity plays a critical role. In this view, medication that acts on dopamine receptors alters the brain's response to dopamine, reducing the medication's effectiveness.
Symptoms
Doctors often categorize schizophrenia into positive and negative symptoms. Positive symptoms include:
- Delusions, or false beliefs
- Hallucinations, or false sensory experiences
- Thought disorders
- Disorganized thinking or behavior
Negative symptoms refer to the absence of typical behaviors and include symptoms such as:
- Low motivation
- Depression and difficulty feeling pleasure
- Speech problems
People with treatment-resistant schizophrenia may still experience positive symptoms even with treatment. They may also experience negative symptoms, although this is not required for a diagnosis.
Diagnosis
Doctors diagnose schizophrenia based on symptoms. To qualify for a diagnosis, someone must exhibit at least two symptoms for more than six months. These symptoms include:
- Hallucinations
- Delusions
- Disorganized speech
- Catatonic behavior, or slow or “frozen” movement, or disorganized behavior
- Negative symptoms such as low motivation and the inability to feel pleasure
To diagnose treatment-resistant schizophrenia, a person must have tried at least two antipsychotic schizophrenia medications, at the usual dose, for at least six weeks, without seeing significant improvement in positive symptoms.
Diagnosing someone with treatment-resistant schizophrenia typically takes at least 12 weeks following a schizophrenia diagnosis.
Treatment
Clozapine is often the first-line treatment for treatment-resistant schizophrenia. Other options include:
- Higher doses of schizophrenia medications
- Combining multiple schizophrenia medications
- Brain stimulation therapies such as:
- Electroconvulsive therapy
- Transcranial magnetic stimulation
- Psychotherapy
Individuals may also require various forms of social support, including family therapy, a social worker's assistance in connecting to resources, and accommodations at work or school.
Schizophrenia medications can often cause severe side effects. As a result, a person may need help managing these side effects or may need to occasionally adjust their treatment plan.
When to contact a doctor
Schizophrenia can lead a person to believe things that are not true or sense things that are not there, making it challenging for them to realize they have the condition or that it does not respond to treatment.
In addition to typical schizophrenia symptoms, such as delusions and hallucinations, some signs that treatment may not be working include:
- A person feels anxious or upset about things others do not believe or see.
- Friends or loved ones continue to express concern about a person’s emotions or behavior.
- A person feels that their life has not improved with medication.
- An individual feels like they think or live very differently from others.
Additionally, a person may benefit from extra support if:
- Side effects of medications are severe or intolerable
- There are difficulties remembering to take medication
- Treatment seems to have stopped working
Outlook
Managing treatment-resistant schizophrenia can be challenging, and a person may continue to face issues with treatment. A 2021 study of 63 people with treatment-resistant schizophrenia found that 25% responded to clozapine, the first-line treatment.
Certain factors that correlated with a higher likelihood of treatment response included:
- Improved social interactions and behavior in the youth period prior to diagnosis identification
- Manifesting the paranoid variant of schizophrenia
- Not delaying the utilization of clozapine for more than 7 years
- At least one unconventional antipsychotic drug trial for schizophrenia treatment
It should be noted that demographic and biological factors did not influence the response to therapy.
Summary
Dealing with treatment-resistant schizophrenia can pose difficulties, particularly when the ailment impairs one's life and social components.
However, the resistance to therapy does not signify that schizophrenia is entirely incurable. By collaborating with a skilled treatment provider and clinically appropriate medication dosage, a person might experience substantial improvement.
Additional approaches can also be helpful. Psychotherapy can aid in managing schizophrenia symptoms and assist an individual in learning self-advocacy and living with their diagnosis. Brain stimulation treatments, such as electroconvulsive therapy, may help rejuvenate the brain, alleviating schizophrenia symptoms over the long term.
Individuals with this condition must collaborate with an informed treatment group, including a psychiatrist.
The field of neurology and psychology often collaborate in the study of treatment-resistant schizophrenia, as its causes may involve brain inflammation and neurotransmitter dysfunctions. Individuals undergoing treatment for schizophrenia, including those with treatment-resistant forms, may also receive support from mental health professionals such as psychiatrists, social workers, and psychotherapists to manage symptoms and improve overall health.
