Background: The concept of difficult to treat schizophrenia (DTTS) was described about 25 years back. However, the prevalence of various features which make a patient with schizophrenia, difficult to treat has not been explored. Aim: The aim of the study was to evaluate the prevalence of various treatment-related features, which makes a patient DTTS. Methodology: For this study, 157 patients with treatment-resistant schizophrenia (TRS) were evaluated for various clinical features, which indicated that these patients were also having DTTS. Results: The most common criteria fulfilled by the participants were inadequate response to the atypical antipsychotics (96.8%), followed by poor medication adherence (75.8%) and having duration of untreated psychosis of more than 1 year (75.8%). About two-third (68.8%) of the participants also fulfilled the criteria of having experienced adverse effects due to the atypical antipsychotics (68.8%) and more than half (56.1%) of the participants reported inadequate response to typical antipsychotics. Other features seen in less than half of the participants were the presence of psychiatric comorbidity (43.3%), presence of treatment failure (relapse while on a dose of antipsychotic that previously had shown response) (40.8%), and adverse effects due to the typical antipsychotics (36.3%). Overall, 94.2% of the study participants fulfilled at least three abnormalities, and when the cut-off was raised to five abnormalities, the prevalence was 54.5%. When the cut-off of 6 features was used the prevalence of DTTS was 35.6%. Conclusions: Significant proportion of patients with TRS has three or more features of DTTS and an active evaluation for these factors during assessment and management of a patient with schizophrenia may help in better understanding of the prognosis and the treatment needs of the patients.
Grover et al. (2026) studied this question.