Informe nº Osteba D12-04. - Euskadi.net

Several authors have tried to define the refractory nature of anti-psychotic treatments. The most extensiveuntil now are those of Kane (1988). Although these were accepted by most of the scientific community,they have been the subject of numerous criticisms to the point where at this time they arenon-operative or at least refer to very partial aspects of refractarity in schizophrenia. This guideline dealswith this subject and proposes the admission of refractarity criteria in accordance with the groups thatare developing remission criteria at this time (Andreasen and cols 2005).AIMS• Systematise the multiplicity of inclusion criteria in Refractory Schizophrenia.• Systematise the remission concept in schizophrenia.• Study the impact of those components of greatest difficulty in the treatment: cognition, suicide andviolence.• Create a guideline of efficient pharmacological and psychosocial treatments in refractory schizophreniasthat can be used for the clinical orientation of psychiatrists, psychologists and nurses specialised inMental Health.METHODS• Systematic review of the scientific literature over recent years in the most common databases in medicineand in international reference institutions. Identification of national and international guidelinesexisting in this field.• Identification and listing of other treatment methods, techniques and standardised programmes inpsychiatry, used in the psychoses described in scientific articles and clinical and experimental centresin accordance with the scientific quality.• Selection of treatments in accordance with evidence of their efficacy, the impact rate of publicationsand the experience of the research/clinical group.The following sources have been included:Clinical Guidelines: Clinical Guideline for psychiatric disorders of the American Psychiatric Association,Gaskell and the British Psychological Society, International Journal of Psychiatry and Clinical Practice (Algorithmsfor acute pharmacotherapy in treatment of schizophrenia disorders), Expert Consensus Guidelineseries (1999 y 2003), The Expert Consensus Panel for Optimizing Pharmacologic Treatment ofPsychotic Disorders, Canadian Clinical Practice Guidelines for the Treatment of Schizophrenia, NationalInstitute for Clinical Excellence (Schizophrenia: core interventions in the treatment and managementof schizophrenia in primary and secondary care, years 2002 and 2009), The Schizophrenia PORT PharmacologicalTreatment Recommendations. The World Federations of Societies of Biological Psychiatry(Treatment Guidelines on Schizophrenia ).Databases: Medline, Central (Cochrane Library), OVID. MeSH: Schizophrenia, Treatment Resistant SchizophreniaPsychosocial Interventions.Textbooks: Textbook of Schizophrenia (Liberman). Schizophrenia (Hirsch & Weinberger). Textbook ofPsychopharmacology (Schatzberg & Nemeroff).Economic analysis: YES NO Expert opinion: YES NO20