Skip to main content

Biology of Schizophrenia: Is Treatment Refractoriness Synonymous with Severity of Illness [A.K.A. Is This a Drug Efficacy Problem or an Expression of Severe Illness?]

  • Chapter
  • First Online:
Treatment–Refractory Schizophrenia

Abstract

Approximately one-quarter of individuals develop schizophrenia in early childhood and adolescence. Typically, the course of illness in these patients is deteriorative. Moreover, longitudinal evaluation of chronic relapsing illness reveals evidence of neurodegenerative tissue loss. There is some evidence—albeit preliminary and somewhat controversial—that antipsychotic medications can obviate and/or ameliorate these changes. This chapter will describe the neurobiology of schizophrenia with a focus on the timing, evolution, and putative neurobiological correlates of treatment-refractoriness in schizophrenia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 64.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 84.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abi-Dargham A, Rodenhiser J, Printz D, Zea-Ponce Y, Gil R, Kegeles LS et al (2000) Increased baseline occupancy of D2 receptors by dopamine in schizophrenia. Proc Natl Acad Sci USA 97(14):8104–8109

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Andreasen N, Carpenter W Jr, Kane JM, Lasser R, Marder S, Weinberg D (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 162:441–449

    Article  PubMed  Google Scholar 

  • Borgio J, Rocha D, Elkis H, Bressan R (2010) Neuroimagning in treatment-resistant schizophrenia. In: Elkis H, Meltzer H (eds) Therapy-resistant schizophrenia. Karger, Basel, pp 63–73

    Chapter  Google Scholar 

  • Buchsbaum MS, Shihabuddin L, Brickman AM, Miozzo R, Prikryl R, Shaw R et al (2003) Caudate and putamen volumes in good and poor outcome patients with schizophrenia. Schizophr Res 64(1):53–62

    Article  PubMed  Google Scholar 

  • Buckley P, Miller A, Olsen J, Garver D, Miller DD, Csernansky J (2001) When symptoms persist: clozapine augmentation strategies. Schizophr Bull 27(4):615–628

    Article  CAS  PubMed  Google Scholar 

  • Cordeiro Q, Miguita K, Miracca E, Elkis H, Vallada H (2006) Investigation of possible association between Ser9Gly polymorphism of the D3 dopaminergic receptor gene and response to typical antipsychotics in patients with schizophrenia. Sao Paulo Med J 124(3):165–167

    Article  PubMed  Google Scholar 

  • Correll C, Kishimoto T, Nielsen J, Kane J (2011) Quantifying clinical relevance in the treatment of schizophrenia. Clin Ther 33(12):B16–B39

    Article  PubMed Central  PubMed  Google Scholar 

  • Demjaha A, Murray RM, McGuire PK, Kapur S, Howes OD (2012) Dopamine synthesis capacity in patients with treatment-resistant schizophrenia. Am J Psychiatry 169(11):1203–1210

    Article  PubMed  Google Scholar 

  • Elkis H (2007) Treatment-resistant schizophrenia. Psychiatr Clin North Am 30(3):511–533

    Article  PubMed  Google Scholar 

  • Elkis H (2010) History and current definitions of treatment-resistant schizophrenia. In: Elkis H, Meltzer H (eds) Therapy-resistant schizophrenia. Karger, Basel, pp 1–8

    Chapter  Google Scholar 

  • Friedman L, Knutson L, Shurell M, Meltzer HY (1991) Prefrontal sulcal prominence is inversely related to response to clozapine in schizophrenia. Biol Psychiatry 29(9):865–877

    Article  CAS  PubMed  Google Scholar 

  • Friedman L, Lys C, Schulz SC (1992) The relationship of structural brain imaging parameters to antipsychotic treatment response: a review. J Psychiatry Neurosci 17(2):42–54

    CAS  PubMed Central  PubMed  Google Scholar 

  • Gama CS, Kunz M, Magalhaes PV, Kapczinski F (2013) Staging and neuroprogression in bipolar disorder: a systematic review of the literature. Rev Bras Psiquiatr 35(1):70–74

    Article  PubMed  Google Scholar 

  • Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J et al (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 178:506–517

    Article  CAS  PubMed  Google Scholar 

  • Henna Neto J, Elkis H (2007) Clinical aspects of super-refractory schizophrenia: a 6-month cohort observational study. Rev Bras Psiquiatr 29(3):228–232

    Article  PubMed  Google Scholar 

  • Henquet C, Di Forti M, Morrison P, Kuepper R, Murray RM (2008) Gene-environment interplay between cannabis and psychosis. Schizophr Bull 34(6):1111–1121

    Article  PubMed Central  PubMed  Google Scholar 

  • Hosak L (2007) Role of the COMT gene Val158Met polymorphism in mental disorders: a review. Eur Psychiatry 22(5):276–281

    Article  PubMed  Google Scholar 

  • Hotta Y, Ohnuma T, Hanzawa R, Shibata N, Maeshima H, Baba H et al (2011) Association study between disrupted-in-schizophrenia-1 (DISC1) and Japanese patients with treatment-resistant schizophrenia (TRS). Prog Neuropsychopharmacol Biol Psychiatry 35(2):636–639

    Article  PubMed  Google Scholar 

  • Howes OD, Kapur S (2009) The dopamine hypothesis of schizophrenia: version III–the final common pathway. Schizophr Bull 35(3):549–562

    Article  PubMed Central  PubMed  Google Scholar 

  • Inada T, Nakamura A, Iijima Y (2003) Relationship between catechol-O-methyltransferase polymorphism and treatment-resistant schizophrenia. Am J Med Genet B Neuropsychiatr Genet 120B(1):35–39

    Article  PubMed  Google Scholar 

  • Jaaro-Peled H, Hayashi-Takagi A, Seshadri S, Kamiya A, Brandon NJ, Sawa A (2009) Neurodevelopmental mechanisms of schizophrenia: understanding disturbed postnatal brain maturation through neuregulin-1-ErbB4 and DISC1. Trends Neurosci 32(9):485–495

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Jarskog L, Gilmore J (2006) Neuroprogressive theories. In: Lieberman J, Stroup TS, Perkins D (eds) Textbook of schizophrenia. The American Psychiatric Publishing, Washington DC, pp 137–149

    Google Scholar 

  • Javitt D, Laruelle M (2006) Neurochemical theories. In: Lieberman J, Stroup S, Perkins D (eds) Textbook of schizophrenia. American Psychiatric Publishing, Washington DC, pp 85–116

    Google Scholar 

  • Ji X, Takahashi N, Saito S, Ishihara R, Maeno N, Inada T et al (2008) Relationship between three serotonin receptor subtypes (HTR3A, HTR2A and HTR4) and treatment-resistant schizophrenia in the Japanese population. Neurosci Lett 435(2):95–98

    Article  CAS  PubMed  Google Scholar 

  • Jia P, Jayathilake K, Zhao Z, Meltzer HY (2011) Association of FAS, a TNF-alpha receptor gene, with treatment resistant schizophrenia. Schizophr Res 129(2–3):211–212

    Article  PubMed  Google Scholar 

  • Kane J, Honigfeld G, Singer J, Meltzer H (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45(9):789–796

    Article  CAS  PubMed  Google Scholar 

  • Lambert T (2010) Disease management: multidimensional approaches to incomplete recovery in psychosis. In: Elkis H, Meltzer H (eds) Therapy-resistant schizophrenia. Karger, Basel, pp 87–113

    Chapter  Google Scholar 

  • Lawrie SM, Ingle GT, Santosh CG, Rogers AC, Rimmington JE, Naidu KP et al (1995) Magnetic resonance imaging and single photon emission tomography in treatment-responsive and treatment-resistant schizophrenia. Br J Psychiatry 167(2):202–210

    Article  CAS  PubMed  Google Scholar 

  • Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO et al (2004) Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 161(2 Suppl):1–56

    PubMed  Google Scholar 

  • Leucht S, Kane JM (2006) Measurement-based psychiatry: definitions of response, remission, stability, and relapse in schizophrenia. J Clin Psychiatry 67(11):1813–1814

    Article  PubMed  Google Scholar 

  • Leucht S, Davis J, Engel R, Kissling W, Kane J (2009) Definitions of response and remission in schizophrenia: recommendations for their use and their presentation. Acta Psychiatr Scand 438(Suppl):7–14

    Article  Google Scholar 

  • Lin A, Kenis G, Bignotti S, Tura GJ, De Jong R, Bosmans E et al (1998) The inflammatory response system in treatment-resistant schizophrenia: increased serum interleukin-6. Schizophr Res 32(1):9–15

    Article  CAS  PubMed  Google Scholar 

  • Luca VD, Souza RP, Panariello F, Meltzer H (2010) Genetic studies in treatment-resistant schizophrenia. In: Elkis H, Meltzer H (eds) Therapy-resistant schizophrenia. Karger, Basel, pp 52–62

    Chapter  Google Scholar 

  • Maes M, Bocchio Chiavetto L, Bignotti S, Battisa Tura GJ, Pioli R, Boin F et al (2002) Increased serum interleukin-8 and interleukin-10 in schizophrenic patients resistant to treatment with neuroleptics and the stimulatory effects of clozapine on serum leukemia inhibitory factor receptor. Schizophr Res 54(3):281–291

    Article  PubMed  Google Scholar 

  • Meltzer H (2010) The role of clozapine in treatment-resistant schizophrenia. In: Elkis H, Meltzer H (eds) Therapy-resistant schizophrenia. Karger, Basel, pp 114–128

    Chapter  Google Scholar 

  • Meltzer H, Li Z, Kaneda Y (2003) Serotonin receptors: their key role in drugs to treat schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 27(7):1159–1172

    Article  CAS  PubMed  Google Scholar 

  • Meltzer HY, Massey BW, Horiguchi M (2012) Serotonin receptors as targets for drugs useful to treat psychosis and cognitive impairment in schizophrenia. Curr Pharm Biotechnol 13(8):1572–1586

    Article  CAS  PubMed  Google Scholar 

  • Mitelman SA, Buchsbaum MS (2007) Very poor outcome schizophrenia: clinical and neuroimaging aspects. Int Rev Psychiatry 19(4):345–357

    Article  PubMed Central  PubMed  Google Scholar 

  • Mitelman SA, Brickman AM, Shihabuddin L, Newmark RE, Hazlett EA, Haznedar MM et al (2007) A comprehensive assessment of gray and white matter volumes and their relationship to outcome and severity in schizophrenia. Neuroimage 37(2):449–462

    Article  PubMed Central  PubMed  Google Scholar 

  • Mitelman SA, Canfield EL, Chu KW, Brickman AM, Shihabuddin L, Hazlett EA et al (2009a) Poor outcome in chronic schizophrenia is associated with progressive loss of volume of the putamen. Schizophr Res 113(2–3):241–245

    Article  PubMed Central  PubMed  Google Scholar 

  • Mitelman SA, Canfield EL, Newmark RE, Brickman AM, Torosjan Y, Chu KW et al (2009b) Longitudinal assessment of gray and white matter in chronic schizophrenia: a Combined Diffusion-Tensor and Structural Magnetic Resonance Imaging Study. Open Neuroimag J 3:31–47

    Article  PubMed Central  PubMed  Google Scholar 

  • Mitelman SA, Nikiforova YK, Canfield EL, Hazlett EA, Brickman AM, Shihabuddin L et al (2009c) A longitudinal study of the corpus callosum in chronic schizophrenia. Schizophr Res 114(1–3):144–153

    Article  PubMed Central  PubMed  Google Scholar 

  • Mitelman SA, Canfield EL, Brickman AM, Shihabuddin L, Hazlett EA, Buchsbaum MS (2010) Progressive ventricular expansion in chronic poor-outcome schizophrenia. Cogn Behav Neurol 23(2):85–88

    Article  PubMed  Google Scholar 

  • Murray RM, Lappin J, Di Forti M (2008) Schizophrenia: from developmental deviance to dopamine dysregulation. Eur Neuropsychopharmacol 18(Suppl 3):S129–S134

    Article  CAS  PubMed  Google Scholar 

  • Rapoport JL, Giedd JN, Gogtay N (2012) Neurodevelopmental model of schizophrenia: update 2012. Mol Psychiatry 17(12):1228–1238

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Seeman P (1995) Therapeutic receptor-blocking concentrations of neuroleptics. Int Clin Psychopharmacol 10(Suppl 3):5–13

    PubMed  Google Scholar 

  • Sheitman BB, Lieberman JA (1998) The natural history and pathophysiology of treatment resistant schizophrenia. J Psychiatr Res 32(3–4):143–150

    Article  CAS  PubMed  Google Scholar 

  • Singh SP, Singh V, Kar N, Chan K (2010) Efficacy of antidepressants in treating the negative symptoms of chronic schizophrenia: meta-analysis. Br J Psychiatry 197(3):174–179

    Article  PubMed  Google Scholar 

  • Suzuki T, Remington G, Mulsant BH, Rajji TK, Uchida H, Graff-Guerrero A et al (2011) Treatment resistant schizophrenia and response to antipsychotics: a review. Schizophr Res 133(1–3):54–62

    Article  PubMed  Google Scholar 

  • Teo C, Zai C, Borlido C, Tomasetti C, Strauss J, Shinkai T et al (2012) Analysis of treatment-resistant schizophrenia and 384 markers from candidate genes. Pharmacogenet Genomics 22(11):807–811

    Article  CAS  PubMed  Google Scholar 

  • Tiihonen J, Wahlbeck K, Kiviniemi V (2009) The efficacy of lamotrigine in clozapine-resistant schizophrenia: a systematic review and meta-analysis. Schizophr Res 109(1–3):10–14

    Article  PubMed  Google Scholar 

  • Weinberger DR, Torrey EF, Neophytides AN, Wyatt RJ (1979) Lateral cerebral ventricular enlargement in chronic schizophrenia. Arch Gen Psychiatry 36(7):735–739

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Helio Elkis .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Elkis, H., Buckley, P.F. (2014). Biology of Schizophrenia: Is Treatment Refractoriness Synonymous with Severity of Illness [A.K.A. Is This a Drug Efficacy Problem or an Expression of Severe Illness?]. In: Buckley, P., Gaughran, F. (eds) Treatment–Refractory Schizophrenia. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45257-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-45257-4_2

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-45256-7

  • Online ISBN: 978-3-642-45257-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics