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 criteria which psychiatrists use to judge schizophrenic patients as being refractory in Japan. Based on 258 schizophrenic in-patients (ICD-10) and their likelihood of discharge, level of psychosocial functioning, mental state and use of medication, the common features of patients who are viewed as non-dischargeable because of their severe mental state, compared to those of dischargeable patients, were extracted and used as the criteria. The criteria proposed necessitate (i) diagnosis of schizophrenia by standard operational criteria, (ii) continuous hospitalization for at least the past 2 years, (iii) a level of psychosocial functioning of < or = 40 as measured by the Global Assessment Scale, and (iv) an intensity score of 'marked' or 'severe' on at least three of the six Manchester Scale items (flattened affect, psychomotor retardation, delusions, hallucinations, incoherence of speech and poverty of speech).