Is disorganized schizophrenia a predictor of treatment resistance? Evidence from an observational study

Objective: To investigate whether inpatients with disorganized schizophrenia are more resistant to treatment. Method: Eighty-five inpatients were assessed at admission and at discharge for schizophrenia subtype, symptom severity, and treatment resistance criteria. Results: Disorganized patients were significantly more treatment-resistant than paranoid patients (60%, p = 0.001), and presented worse scores on the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI-S), and the Global Assessment of Functioning Scale (GAF) (p < 0.001). Although the difference was not significant, 80% of treatment-resistant patients with disorganized schizophrenia responded to clozapine. Conclusion: Patients with the disorganized subtype of schizophrenia should benefit from clozapine as a second-line agent. .

Fisiopatologia da esquizofrenia: aspectos atuais / Physiopathology of schizophrenia: current aspects

CONTEXTO: A esquizofrenia é uma das mais intrigantes doenças psiquiátricas e, talvez por isso, a mais pesquisada, com grandes avanços sobre sua fisiopatologia no último século. OBJETIVO: Revisar os principais avanços na compreensão fisiopatológica da esquizofrenia. MÉTODO: Revisão da literatura para cada tópico proposto a partir de artigos levantados no Medline e/ou considerados importantes a partir da experiência dos autores. RESULTADOS: A hipótese dopaminérgica representa uma das primeiras teorias etiológicas e permanece até os dias atuais como uma das que apresenta evidências mais consistentes. No entanto, essa teoria falha em explicar a história natural, os prejuízos cognitivos e as alterações estruturais encontradas na esquizofrenia. A demonstração de estudos epidemiológicos de fatores de risco genéticos e ambientais, somados aos estudos neuropatológicos e de neuroimagem, sugerem um modelo interativo em que inúmeros fatores atuam conjuntamente para alterações mais globais do desenvolvimento cerebral. CONCLUSÃO: A compreensão fisiopatológica da esquizofrenia avançou bastante no último século, evoluindo de teorias etiológicas unicausais para modelos mais complexos que consideram a interação de inúmeros fatores genéticos e ambientais.

BACKGROUND: Schizophrenia is one of the most intriguing and studied psychiatric diseases and its physiopathology has advanced a lot in the last century. OBJECTIVE: To review the most important advances in the physiopathology of schizophrenia. METHOD: Review of the literature of each proposed topic by articles searched in Medline and/or chosen accordingly the authors’ experience. RESULTS: The dopaminergic hypothesis was one of the first ethiological theories and until today is among the ones that presents the most consistent evidences. However, it fails to explain important features found in schizophrenia, such as the natural history, the cognitive impairments and the structural abnormalities. Evidences provided by epidemiological studies of genetic and environmental risk factors, associated with the findings of neuropathological and neuroimaging studies, suggest an interactive model with several factors acting together to create a global alteration of the brain development. CONCLUSION: The physiophatology of schizophrenia has advanced a lot in the last century, evolving from unicausal theories towards more complex models that consider the interaction among several genetic and environmental factors.