Treatment-resistant schizophrenia in Thailand : Its variation in diagnosis
and drug treatment
Pichet Udomratn, Assoc. Prof., D. of Psychiatry, F. of Medicine, PSU.
Manit Srisurapanont, Assoc. Prof., D. of Psychiatry, F. of Medicine, Chiang Mai U., Chiang Mai
Corresponding e-mail : upichet@ratree.psu.ac.th
Grant : The Health System Research Institute (HSRI) of Thailand
Published : International Med J 2000, 7(4) : 273-276
Key words : treatment-resistant, schizophrenia, diagnosis, drug treatment, Thailand
Objectives : To survey Thai psychiatristÕs practice relevant to the issue of treatment-resistant schizophrenia (TRS).
Design : cross-sectional survey
Materials and Methods : Questionnaires were sent out to all members of the Royal College
of Psychiatrists of Thailand. Five issues relevant to the diagnosis and drug treatment of TRS were
covered. They were : factors involved in the diagnosis of TRS, number and dosage of conventional antipsychotics used before the diagnosis of TRS, drugs or combination of drugs used for the treat-
ment of TRS, and first, second, and third-line drug treatments of TRS. Percentage of responses and
chi-square test were used for data analysis.
Results : The data obtained from 98 questionnaires were analyzed. Regarding the factors involved in the diagnosis of TRS, 83.7% and 92.9% respondents took the number and the doses of conventional antipsychotics respectively. Most respondents both considered the use of 3 and more
than 3 antipsychotics and considered that 700-800 mg/day of chlorpromazine or its equivalent were required for the diagnosis of TRS. The first five treatment strategies accepted by the respondents
were switching to risperidone alone (78.6%), switching to another conventional antipsychotic never used before (71.4%), adding carbamazepine to the on-going conventional antipsychotic (64.3%), switching to clozapine alone (57.1%) and adding lithium to the on-going conventional antipsychotic (48.0%). However, the most acceptable first, second, and third line treatment strategies were increas-ing the dose of an on-going conventional antipsychotic (34.7%), switching to another conventional antipsychotic never used before (31.6%), and switching to risperidone alone (16.3%). The variability of first, second, and third line treatment strategies among 4 treatment settings (university hospitals, psychiatric or neurological hospitals, general hospitals, and private hospitals or clinics) was not statistically significant (p=0.88, p=0.20, p=0.83 respectively).
Conclusions : Thai psychiatrists appear to disagree about the exact number and the dose of
TRS. The findings of variability of diagnosis and treatment for TRS suggest a problem in the quality of psychiatric care for Thai TRS patients. The development of a clinical practice guideline for TRS should be helpful for solving this problem.
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