Welcome to the 21st WCP Virtual Congress Program Scheduling

Treatment resistant schizophrenia (TRS) can affect up to 1/3 of patients. It has a significant impact in quality of life and high societal economic costs. A large proportion of these patients are treatment resistant from an early stage of the illness. The most effective treatment for TRS is clozapine, and a delay in its use may result in poorer response. Delay in its indication may be motivated by clinicians’ resistance to prescribe, due to hematological complications and other side effects, but also, the need to make weekly and then monthly hematological testing. Clozapine has relatively low affinity and fast dissociation from D2/D3 receptor, and affects other neurotransmitter systems, such as the glutamatergic. In addition, drug occupancy at dopamine D2/3 receptors have similar levels of receptor occupancy in responders and TRS patients, and some of the latter do not show elevation in dopamine synthesis capacity. This has attracted interest in exploring other pathways to TRS and their potential as biomarkers and therapeutic targets. This session will review TRS from a clinical and socio-demographical perspective, as well as novel tools for diagnosis, and explore early dysregulation of gamma-aminobutyric acid (GABA) and glutamate in early stages of psychosis as a potential biomarker. Early identification of TRS has the potential to reduce time of untreated (or inadequately treated) psychosis in a critical period, improving long term clinical outcomes, as well as minimizing functional disability and social burden resulting from prolonged psychosis.