Demographic Profile and Management Strategies of Treatment Resistant Schizophrenia and Treatment Resistant Depression in a Tertiary Care Referral Hospital

Treatment resistance is an emerging issue faced by physicians worldwide. The incidence of treatment resistance in schizophrenia is about 20%. Factors that may contribute to it include non-adherence to treatment, comorbid conditions and medication side effects. Clozapine, augmentation of clozapine with benzamides (sulpiride, amisulpride), antiepileptics (lamotrigine) and atypical antipsychotics shows some success in management of TRS. In extreme treatment resistance, a strategy is recommended that combines the proven best drug for the particular patient and psychosocial treatments. Treatment resistant depression is a severely disabling disorder which affects about 30-46% of patients with major depressive disorder. Although there are no proven treatment options, therapeutic strategies which include optimization of medications, a combination or switching of anti-depressants and an augmentation with non-antidepressants, psychosocial and cultural therapies and somatic therapies including ECT etc. are used. The current study was aimed at evaluating the demographic profile and management of treatment resistant schizophrenia and treatment resistant depression in psychiatric department of a tertiary care super-specialty hospital. The design of the study was prospective observational and a total of 52 subjects were enrolled in the study of which 25 subjects were diagnosed with TRS and 27 were diagnosed with TRD. Treatment resistant cases in the hospital setting were identified by using PANSS and MADRS scales. We evaluate the treatment provided for those patients and monitor for improvement of conditions. Even though many treatment options are available, a well-defined management guideline is not yet established. So we hope this study may contribute something new to the health care professionals, thereby helps improve patient care. From the evaluation of the demographic profile, it concluded that the gender doesn‟t have much influence on the occurrence of TRS. But in cases of TRD, females had predominance over males. Furthermore family history had a strong correlation with the occurrence of both TRD and TRS. Clozapine is used as a gold standard in treatment of TRS. Augmentation of clozapine with other antipsychotics in different doses has shown clinical improvement in patients. Sertraline, Venlafaxine and Sodium valproate combination was majorly used in the treatment of TRD patients. Among them, Venlafaxine was used commonly in TRD. Adverse drug reactions are common with the use of antipsychotic drugs. There for this study monitor the occurrence of major adverse drug reactions in patients with TRS and TRD. In this study the major ADRs shown by TRS patients include weight gain, constipation, diabetes mellitus, extra pyramidal symptoms, sexual dysfunction and tachycardia and those of TRD patients include weight changes, GI problems and sexual dysfunction. The study concluded that in TRS, this specific population unresponsive to previous treatment, a combination of clozapine with aripiprazole, as well as other augmentation strategies for clozapine, seen worthy of further exploration. It also concluded that TRD may benefit from treatment with a more potent anti-depressant from the tricyclic anti-depressant class or selective serotonin reuptake inhibitor or using antipsychotic medication or selective nor epinephrine reuptake inhibitor or mood stabilizing medication such as lithium may hold the key to their recovery.