Treatment of the refractory schizophrenic patient.

As antipsychotic treatment evolves toward a broader range of efficacy and more benign side effect profiles, our criteria for treatment-refractory schizophrenia may become more subtle. Unidimensional concepts of treatment resistance may be replaced by multiaxial descriptions of the target symptoms, side effects, and compliance issues that limit the ultimate goals of enhanced psychosocial function and quality of life. Augmentation strategies, increasing insight into dose response relationships, and atypical agents may benefit patients who failed to respond to or tolerate previous therapies. The advantages of newer agents in treatment-resistant schizophrenia may arise in part from their preferential targeting of newer agents in treatment-resistant schizophrenia may arise in part from their preferential targeting of mesolimbic compared with motor and tuberoinfundibular dopaminergic pathways.