Shortening Duration of Treatment Resistance: The Next Step in the Treatment of Schizophrenia

Abstract

Abstract The early psychosis movement was fuelled by the concept that early recognition and treatment of patients with psychosis could prevent long-term chronic impairment. Indeed, duration of untreated psychosis (DUP) predicts treatment response and early intervention services have since shown added value. However, considerable chronic impairment remains, with about 20%–30% of the patients with schizophrenia not responding to 2 different conventional antipsychotics in adequate doses and duration. In contrast to the research on DUP and early intervention in schizophrenia in general, far less research has systemically assessed the benefits of shortening the time between treatment onset and adequate treatment response. Yet timely recognition of treatment-resistant schizophrenia (TRS) could be vital since studies have indicated that a critical time window in which clozapine is most effective for TRS patients could exist. We believe that introducing the concept of Duration of Treatment Resistance (DTR) may help to investigate whether shortening of DTR by optimizing medication schedules can further prevent or mitigate long-term disability in patients with schizophrenia. In this editorial, we propose a definition of DTR and encourage the field to investigate the potential merits of this concept in future studies.