Friday, Oct. 20
14:30 – 15:30 (N/A)
Meeting Room: Finback (3rd floor – B Tower)
Suze Berkhout*, MD/PhD; Oshan Fernandes, PhD; Leighton Schreyer, BSc; Vanessa Lockwood, SSW; Gary Remington, MD, PhD; Peter Giacobbe, MD, MSc.; Sophie Soklaridis, PhD; Melanie Anderson, MLIS; Carol Borlido, BSc.; Araba Chintoh, MD, PhD; Csilla Kalocsai, PhD

CanMEDS Roles:

1. Scholar
2. Collaborator
3. Medical Expert

At the end of this session, participants will be able to: 1) Understand the historical and social contingencies that have shaped the definitions of treatment resistance in schizophrenia and depression; 2) Critically engage with the ways experimental methods, interventions, and technologies contribute to diagnostic labels and categories; and 3) Understand the impact of labelling treatment resistance for psychiatry service users.

Across various diagnoses, a minority of people only minimally respond to standard treatment. Being classified as having a treatment resistant (TR) form of mental illness mobilizes interventions, but what constitutes TR is in flux and little is known about the designation’s impact.
Methods: Through a metanarrative review, we constructed a sociohistorical map of TR in schizophrenia-spectrum and major depressive disorders, examining changing definitions of TR over time. Simultaneously, we explored meanings and impacts of TR as a classification within a qualitative pilot. Open-ended narrative interviews were conducted with service users and providers and thematically analyzed in an interpretivist-critical frame.
Results: In depression and schizophrenia-spectrum illnesses, attempts to resolve the conceptual heterogeneity of TR rely on pharmacocentric definitions, reinforcing biological determinism and the centrality of a curative framework. In contrast, service users’ experiences of symptom refractoriness engaged a broader landscape. Naming an experience as “TR” helped some people make sense of their experiences, but the label was simultaneously seen as foreclosing futurity. For providers, the TR construct was sometimes a dramatization of therapeutic nihilism and not easily disclosed, particularly in psychosis.
Discussion: Bringing the lived experience of TR into conversation with a metanarrative review enabled us to explore the experience of being labelled as “treatment resistant” alongside the practices, methods, and technologies that generate the classification itself. Critical scholarship in psychiatry can benefit from layering methodologies—a systematic approach to thinking about similarities, differences, particularities, and tensions embedded within definitions of TR and how these are embodied.

References:

1. Howes OD, McCutcheon R, Agid O, et al. Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. Am J Psychiatry 2017;174(3):216–229.
2. Howes OD, Thase ME, Pillinger T. Treatment resistance in psychiatry: state of the art and new directions. Mol Psychiatry 2022;27(1):58–72.