Treatment of the Refractory Schizophrenic Patient

As antipsychotic treatment evolves toward a broader range of efficacy and more benign side effectprofiles, our criteria for treatment-refractory schizophrenia may become more subtle. Unidimensionalconcepts of treatment resistance may be replaced by multiaxial descriptions of the target symptoms,side effects, and compliance issues that limit the ultimate goals of enhanced psychosocial function andquality of life. Augmentation strategies, increasing insight into dose response relationships, and atypicalagents may benefit patients who failed to respond to or tolerate previous therapies. The advantagesof newer agents in treatment-resistant schizophrenia may arise in part from their preferential targetingof mesolimbic compared with motor and tuberoinfundibular dopaminergic pathways.