An international research agenda for clozapine-resistant schizophrenia.

Journal: The lancet. Psychiatry

Volume: 10

Issue: 8

Year of Publication: 2023

Affiliated Institutions:  Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; GGNet Mental Health, Warnsveld, Netherlands. Electronic address: j.luykx@maastrichtuniversity.nl. Barcelona Clínic Schizophrenia Unit, Neurosciences Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; UR Center for Mental Health, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Clínica Nuestra Señora de la Paz, Orden Hospitalaria de San Juan de Dios, Bogotá, Colombia. Department of Old Age Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; Division of Psychiatry, Department of Internal Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan. Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; GGNet Mental Health, Warnsveld, Netherlands. Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Jette, Belgium. Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA. Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. Utrecht, Netherlands. Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK. Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand. Department of Psychiatry, Fattouma Bourguiba Hospital, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia. Department of Pharmacology, Fattouma Bourguiba Hospital, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia. Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA. Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan; Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan; Clinical Research and Education Center, Asakayama General Hospital, Sakai, Japan; Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan. Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark. Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany. Department of Child and Adolescent Psychiatry, Charité Universitaetsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA. Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, Augsburg, Germany. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia. Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK. Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden.

Abstract summary 

Treatment-resistant symptoms occur in about a third of patients with schizophrenia and are associated with a substantial reduction in their quality of life. The development of new treatment options for clozapine-resistant schizophrenia constitutes a crucial, unmet need in psychiatry. Additionally, an overview of past and possible future research avenues to optimise the early detection, diagnosis, and management of clozapine-resistant schizophrenia is unavailable. In this Health Policy, we discuss the ongoing challenges associated with clozapine-resistant schizophrenia faced by patients and health-care providers worldwide to improve the understanding of this condition. We then revisit several clozapine guidelines, the diagnostic tests and treatment options for clozapine-resistant schizophrenia, and currently applied research approaches in clozapine-resistant schizophrenia. We also suggest methodologies and targets for future research, divided into innovative nosology-oriented field trials (eg, examining dimensional symptom staging), translational approaches (eg, genetics), epidemiological research (eg, real-world studies), and interventional studies (eg, non-traditional trial designs incorporating lived experiences and caregivers' perspectives). Finally, we note that low-income and middle-income countries are under-represented in studies on clozapine-resistant schizophrenia and propose an agenda to guide multinational research on the cause and treatment of clozapine-resistant schizophrenia. We hope that this research agenda will empower better global representation of patients living with clozapine-resistant schizophrenia and ultimately improve their functional outcomes and quality of life.

Authors & Co-authors:  Luykx Jurjen J JJ Gonzalez-Diaz Jairo M JM Guu Ta-Wei TW van der Horst Marte Z MZ van Dellen Edwin E Boks Marco P MP Guloksuz Sinan S DeLisi Lynn E LE Sommer Iris E IE Cummins Russel R Shiers David D Lee Jimmy J Every-Palmer Susanna S Mhalla Ahmed A Chadly Zohra Z Chan Sherry K W SKW Cotes Robert O RO Takahashi Shun S Benros Michael E ME Wagner Elias E Correll Christoph U CU Hasan Alkomiet A Siskind Dan D Endres Dominique D MacCabe James J Tiihonen Jari J

Study Outcome 

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Citations : 
Authors :  26
Identifiers
Doi : 10.1016/S2215-0366(23)00109-8
SSN : 2215-0374
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
Study Design
Cross Sectional Study
Study Approach
Country of Study
Publication Country
England