Original Title: Estrategias terapéuticas en la esquizofrenia refractaria o esquizofrenia resistente a tratamiento

Authors' objectives: • Systematise the multiplicity of inclusion criteria in Refractory Schizophrenia. • Systematise the remission concept in schizophrenia. • Study the impact of those components of greatest difficulty in the treatment: cognition, suicide and violence. • Create a guideline of efficient pharmacological and psychosocial treatments in refractory schizophrenias that can be used for the clinical orientation of psychiatrists, psychologists and nurses specialised in Mental Health.

Authors' results and conclusions: The guideline proposes remission criteria in accordance with generally-agreed principles at this time, following a review of this subject. It develops definitions of refractory schizophrenia. The paper proposes several different levels of strategic evidence of pharmacological-biological treatment, drawing up conclusions and recommendations for each section. The guideline defines strategies for psychosocial treatment in Refractory Schizophrenia, proposes these with different levels of evidence, and draws up conclusions and recommendations for each section. CONCLUSIONS AND RECOMMENDATIONS The team that has drawn up this Guideline proposes the following definition of treatment resistant schizophrenia: those persons who do not reach the minimum remission threshold in accordance with Andreasen’s criteria. With regard to pharmacological/biological treatment strategies, recommendations and conclusions are made for clozapine, first and second generation antipsychotics, secondary effects of antipsychotics, antipsychotic polytherapy, antipsychotic enhancements, electroconvulsive therapy and magnetic transcranial stimulation therapy. With regard to psychosocial treatment strategies, a number of conclusions and recommendations are reviewed and established for: vocational rehabilitation, family interventions, behavioural therapy, cognitive restructuring therapy or cognitive therapy of schizophrenia, psychoeducation, community assertive therapy, group psychotherapy, neuropsychological rehabilitation, psychoanalytical and psychodynamic psychotherapies and finally, art therapies or art therapy for schizophrenia. The guideline is structured according to a gradient of evidence in strategies for dealing with resistant schizophrenia based on pragmatism and utility criteria. We understand that the guideline may be applied to the evaluation of widely used therapeutic strategies and in this context, may help in the planning of health resources. Special emphasis has been placed on revealing the positive and negative aspects of current practice in the treatment of treatment resistant schizophrenia and is therefore oriented towards priorities and requirements of the research in this field.

Authors' methods: • Systematic review of the scientific literature over recent years in the most common databases in medicine and in international reference institutions. Identification of national and international guidelines existing in this field. • Identification and listing of other treatment methods, techniques and standardised programmes in psychiatry, used in the psychoses described in scientific articles and clinical and experimental centres in accordance with the scientific quality. • Selection of treatments in accordance with evidence of their efficacy, the impact rate of publications and the experience of the research/clinical group. The following sources have been included: Clinical Guidelines: Clinical Guideline for psychiatric disorders of the American Psychiatric Association, Gaskell and the British Psychological Society, International Journal of Psychiatry and Clinical Practice (Algorithms for acute pharmacotherapy in treatment of schizophrenia disorders), Expert Consensus Guideline series (1999 y 2003), The Expert Consensus Panel for Optimizing Pharmacologic Treatment of Psychotic Disorders, Canadian Clinical Practice Guidelines for the Treatment of Schizophrenia, National Institute for Clinical Excellence (Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care, years 2002 and 2009), The Schizophrenia PORT Pharmacological Treatment Recommendations. The World Federations of Societies of Biological Psychiatry (Treatment Guidelines on Schizophrenia ). Databases: Medline, Central (Cochrane Library), OVID. MeSH: Schizophrenia, Treatment Resistant Schizophrenia Psychosocial Interventions. Textbooks: Textbook of Schizophrenia (Liberman). Schizophrenia (Hirsch & Weinberger). Textbook of Psychopharmacology (Schatzberg & Nemeroff).

Project Status: Completed

Year Published: 2012

URL for published report: https://www.euskadi.eus/contenidos/informacion/2012_osteba_publicacion/es_def/adjuntos/Osteba%20D-12-04%20esquizofrenia%20refractaria.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>