Evolution of the Concept of Treatment-Resistant Schizophrenia

Therapy-resistant schizophrenia and its subtype, ultra-resistant schizophrenia, remain one of the most serious socially significant psychiatric disorders. The lack of unified diagnostic criteria complicates the interpretation of research data in this area and reduces the effectiveness of therapy in real clinical practice. The development of standardised approaches and in-depth study of resistance mechanisms remain priority tasks of modern psychiatry. The analysis of the literature shows that ideas about therapy-resistant schizophrenia have changed significantly over the last decades. This narrative review considers the criteria for treatment-resistant schizophrenia from the first criteria proposed by Kane et al. to the current ones, including TRRIP, which take into account the duration of therapy, the dose of the drug, the form of its administration, and the patient's compliance. Special attention is paid to the criteria for ultra-resistant schizophrenia in the absence of therapeutic response to clozapine. Currently, there are significant differences in the definition of therapy-resistant schizophrenia, which underline the need to unify its diagnostic criteria.