Treatment-Resistant Schizophrenia
Treatment-resistant schizophrenia refers to schizophrenia or related psychotic disorders in which psychotic symptoms persist despite adequate trials of antipsychotic medications and comprehensive psychosocial interventions. Individuals with treatment-resistant schizophrenia often experience significant functional impairment, recurrent hospitalizations, and elevated clinical risk, requiring specialized and coordinated care.
Patients with treatment-resistant schizophrenia may present with:
- Persistent positive symptoms such as hallucinations or delusions
- Prominent negative symptoms or cognitive impairment
- Limited or partial response to multiple antipsychotic medications
- Intolerance or adverse effects from standard treatments
- Co-occurring mood symptoms, substance use, or medical comorbidities
Our Approach to Treatment-Resistant Schizophrenia
At the UTHealth Houston Center for Interventional Psychiatry, patients with treatment-resistant schizophrenia undergo a comprehensive diagnostic and clinical evaluation to confirm diagnosis, assess treatment history, and identify factors contributing to poor response. Care is guided by a matched-care framework that emphasizes safety, functional recovery, and continuity.
Evaluation includes:
- Review of prior antipsychotic trials and adherence
- Assessment of symptom severity, insight, and functional capacity
- Evaluation of suicide risk, aggression risk, and medical comorbidities
- Consideration of psychosocial supports and rehabilitation needs
Based on this assessment, patients are matched to the most appropriate level of care, ranging from outpatient services to intensive outpatient, partial hospitalization, or inpatient treatment.
Treatment Options
Treatment plans are individualized and may include:
- Optimization of antipsychotic therapy, including clozapine when indicated and appropriate
- Adjunctive pharmacologic strategies targeting mood, anxiety, or behavioral symptoms
- Psychosocial and rehabilitative interventions, integrated with medical treatment
- Interventional therapies, particularly for severe or refractory symptoms, including:
- Electroconvulsive Therapy (ECT), when clinically indicated
- Other advanced interventions based on symptom profile and safety considerations
The use of interventional treatments is guided by clinical evidence, individual risk–benefit assessment, and shared decision-making with patients and families.
Continuity and Functional Recovery
Care for treatment-resistant schizophrenia emphasizes long-term engagement, relapse prevention, and functional recovery. Patients may move between levels of care as clinical needs change, with coordinated transitions to support stability and continuity.
Through this integrated approach, the Center aims to improve outcomes and quality of life for individuals living with treatment-resistant schizophrenia, while supporting safety and sustained engagement in care.