Most patients had significant improvement in psychiatric symptoms after antipsychotic treatment; however, most patients failed to meet the strict criteria for remission, and a large proportion of patients had residual refractory symptoms:
Before diagnosis of refractory schizophrenia, clinicians should exclude or determine the cause of "pseudo refractory schizophrenia".
- Simultaneous mental disorders, substance use disorders, or physical disorders
Non-compliance with prescribed medication regimens
Prior to the diagnosis of refractory diseases, non-drug treatment should be evaluated and optimized.
The triggers and stressors that contribute to aggravation should be addressed through joint efforts with the patient and his/her support system.
Evidence-based psychosocial interventions should be provided to patients with appropriate indications.
The history of attempted treatment of schizophrenia should be obtained from patients, family members and their therapists, including the duration, maximum dose and remission of previous attempted use of antipsychotic drugs (including clozapine and other drugs).
Preliminary treatment of symptoms that have not been alleviated or partially alleviated by an antipsychotic drug, including adjusting the dosage of an antipsychotic drug and using another antipsychotic drug, will be discussed separately.
For schizophrenic patients who have used two antipsychotic drugs and have been treated with the maximum tolerable dose within the therapeutic dose range for at least 6 weeks and still have persistent and clinically significant positive symptoms of schizophrenia, we recommend clozapine instead of other antipsychotic drugs (Grade 1A).
Evidence from clinical trials does not strongly support synergistic treatment with antipsychotics. Synergistic treatment of antipsychotics should only be used for patients with persistent and clinically significant symptoms that meet the above criteria for clozapine treatment, and for patient