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  • Rates of treatment-resistant schizophrenia from first-episode cohorts: systematic review and meta-analysis

    Author(s)
    Siskind, Dan
    Orr, Stacy
    Sinha, Surabhi
    Yu, Ou
    Brijball, Bhavna
    Warren, Nicola
    MacCabe, James H
    Smart, Sophie E
    Kisely, Steve
    Griffith University Author(s)
    Kisely, Steve R.
    Year published
    2021
    Metadata
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    Abstract
    BACKGROUND: Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias. AIMS: We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access. METHOD: We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included ...
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    BACKGROUND: Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias. AIMS: We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access. METHOD: We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies. RESULTS: Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1-27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5-30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11-2.21, P = 0.010). CONCLUSIONS: Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.
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    Journal Title
    The British Journal of Psychiatry
    DOI
    https://doi.org/10.1192/bjp.2021.61
    Note
    This publication has been entered as an advanced online version in Griffith Research Online.
    Subject
    Psychiatry (incl. psychotherapy)
    Psychology
    Clinical sciences
    Schizophrenia
    meta-analysis
    rates
    systematic review
    treatment-resistant schizophrenia
    Publication URI
    http://hdl.handle.net/10072/411807
    Collection
    • Journal articles

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