Drs Osser and Albert have essentially raised three questions. First, how should clinicians and researchers define "treatment resistant"? Second, is it useful clinically or heuristically to distinguish lack of adequate response to neuroleptics from lack of any response at all? Third, if this distinction is made, does response to clozapine differ between these two subgroups?Our study of clozapine's efficacy in "treatment-resistant" patients did include some individuals who may have had a partial response to neuroleptics, as our criteria required patients who had "failed to respond adequately" and who scored at least 46 on the Brief Psychiatric Rating Scale, including scores of at least moderately ill on two of the four psychotic items included on that scale. In addition, the physician had to make an overall evaluation using the Clinical Global Impressions Scale that the patient was at least moderately ill (a score of 4 or more). In
Kane JM, Honigfeld G, Singer J, Meltzer HY. Is Clozapine Response Different in Neuroleptic Nonresponders vs Partial Responders?-Reply. Arch Gen Psychiatry. 1990;47(2):189–190. doi:10.1001/archpsyc.1990.01810140089013
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