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Treatment-resistant symptoms occur in about a third of patients with schizophrenia and are associated with a substantial reduction in their quality of life. The development of new treatment options for clozapine-resistant schizophrenia constitutes a crucial, unmet need in psychiatry. Additionally, an overview of past and possible future research avenues to optimise the early detection, diagnosis, and management of clozapine-resistant schizophrenia is unavailable. In this Health Policy, we discuss the ongoing challenges associated with clozapine-resistant schizophrenia faced by patients and health-care providers worldwide to improve the understanding of this condition. We then revisit several clozapine guidelines, the diagnostic tests and treatment options for clozapine-resistant schizophrenia, and currently applied research approaches in clozapine-resistant schizophrenia. We also suggest methodologies and targets for future research, divided into innovative nosology-oriented field trials (eg, examining dimensional symptom staging), translational approaches (eg, genetics), epidemiological research (eg, real-world studies), and interventional studies (eg, non-traditional trial designs incorporating lived experiences and caregivers' perspectives). Finally, we note that low-income and middle-income countries are under-represented in studies on clozapine-resistant schizophrenia and propose an agenda to guide multinational research on the cause and treatment of clozapine-resistant schizophrenia. We hope that this research agenda will empower better global representation of patients living with clozapine-resistant schizophrenia and ultimately improve their functional outcomes and quality of life.

Patients that achieve clinical remission after a first episode of psychosis (FEP) present fewer relapses, lower consumption of health care resources and a better quality of life even twenty years later. This study aimed to determine the variables related to remission on a multicenter cohort of Spanish patients and its repercussions in functional outcomes.

Olanzapina es un antipsicótico atípico comercializado en Europa desde finales de 1996, que continúa siendo uno de los principios activos más ampliamente utilizados en la actualidad en el territorio español. Sin embargo, su elevada tasa de eventos adversos metabólicos y su uso en algunos escenarios clínicos continúan siendo motivo de controversia. El objetivo de este estudio fue explorar los conocimientos, actitudes y prácticas del uso de este medicamento entre psiquiatras españoles. Se diseñó y distribuyó un cuestionario autodiligenciado en el que se exploraron algunos aspectos posológicos en la práctica clínica, la experiencia y las tendencias de uso en distintos contextos y expectativas a futuro. Se tabularon los datos y se realizó un análisis descriptivo. Se obtuvieron respuestas de 129 psiquiatras en ejercicio de todo el territorio español, con una edad promedio de 45,46 años (SD=9,57) y una razón mujer:hombre de 1,04:1. Tras más de 25 años en el mercado, olanzapina continúa siendo un antipsicótico ampliamente usado en distintos escenarios clínicos en la esquizofrenia y otros trastornos mentales (preferiblemente a dosis entre 5 y 10 mg/día). Los psiquiatras españoles están familiarizados con la necesidad de establecer estrategias farmacológicas y no farmacológicas para el control metabólico de quienes usan este medicamento.

Healthcare workers have faced an unprecedented workload in overstretched health facilities during the COVID-19 pandemic, and we describe various initiatives to support them. Psychological, financial and peer support, accommodation and meal services, proper personal protective equipment, applause and gratitude in the community, spiritual and religious life, child care and volunteering were identified. The potential effects of the COVID-19 pandemic – permanent stress, burnout and other mental health problems among healthcare professionals – can be expected to grow. Continued monitoring is essential to bolster resilience among healthcare workers and prevent the possible consequences for their mental health.