title: The effect of lifetime adversities on resistance to antipsychotic treatment in schizophrenia patients.
abstract: OBJECTIVE
  The aim of this study is to examine whether there is an association between cumulative life adversities and treatment-resistant schizophrenia.
  
  
  METHODS
  We recruited 186 participants diagnosed with schizophrenia spectrum disorders. Adverse life-events were assessed using the Stressful Life Events Screening Questionnaire (SLESQ) and the Childhood Trauma Questionnaire (CTQ). Treatment resistant status was identified using the criteria of the American Psychiatric Association for refractory schizophrenia. We performed a multiple logistic regression model, including life adversities, to predict the treatment resistant status controlling for confounding variables.
  
  
  RESULTS
  Forty two percent of the patients were found to be treatment resistant (n=78) and 58% were non-treatment resistant (n=108). The treatment resistant group had higher score on both SLESQ and CTQ (4.5±3.3 and 54.7±19.7) than the non-treatment resistant group (2.5±2.3 and 47.7±17.5) and the difference between the two groups was significant for both SLESQ (p<0.001) and CTQ (p=0.011). After adjustment for demographic variables and previously reported risk factors of treatment resistance, the association remained significant for SLESQ (OR=1.20, 95% CI 1.05-1.38; p=0.009) but not for CTQ (p=0.13).
  
  
  CONCLUSIONS
  The results suggest that cumulative lifetime adversities could have an independent effect on the resistance to treatment in schizophrenia spectrum disorders. Routine assessment of trauma exposures and an individualized bio-psycho-social formulation is necessary for a personalized treatment.
authors.affiliation: Department of Psychiatry, Centre for Addiction and Mental Health, 250 College Street, M5T 1R8 Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, King Abdulaziz University, Abdullah Sulayman, Jeddah 22254, Saudi Arabia.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Hassan
authors.affiliation: Department of Psychiatry, Centre for Addiction and Mental Health, 250 College Street, M5T 1R8 Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada. Electronic address: vincenzo.deluca@camh.ca.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Luca
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002649:Child Abuse; D004351:Drug Resistance / Q000502:physiology; D005260:Female; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; CTQ; SLESQ; Schizophrenia; Treatment-resistance