Criteria defining refractory schizophrenia

To date there has been no agreement with regard to the criteria that define refractory schizophrenia. In this study, we intended to clarify the criter ia which psychiatrists use to judge schizophrenic patients as being refract ory in Japan. Based on 258 schizophrenic in-patients (ICD-10) and their lik elihood of discharge, level of psychosocial functioning, mental state and u se of medication, the common features of patients who are viewed as non-dis chargeable because of their severe mental state, compared to those of disch argeable patients, were extracted and used as the criteria. The criteria pr oposed necessitate (i) diagnosis of schizophrenia by standard operational c riteria, (ii) continuous hospitalization for at least the past 2 years, (ii i) a level of psychosocial functioning of less than or equal to 40 as measu red by the Global Assessment Scale, and (iv) an intensity score of 'marked' or 'severe' on at least three of the six Manchester Scare items (flattened affect, psychomotor retardation, delusions, hallucinations, incoherence of speech and poverty of speech).