Treatment resistant schizophrenia: Course of brain structure and function

Approximately 30% of people with schizophrenia manifest a minimal response to conventional and atypical antipsychotic medications and manifest continuous symptoms of psychosis, with this condition referred to as “treatment resistant schizophrenia (TRS)”. There are several neurobiological consequences of continuous psychosis, including regional cortical atrophy and ventricular enlargement. Pharmacological treatments are available for TRS, with at least 1/3 of patients responding to treatment with clozapine. In this paper we review the evidence regarding the course of treatment resistant schizophrenia, as well as changes in brain structure and function in psychosis and on the possible role of clozapine treatment in altering cortical deterioration in patients with TRS.