Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review
Despite ongoing attempts to delineate and name treatment resistance (TR) in psychiatry, the term is increasingly deployed across diagnostic categories. Still, what it is that constitutes TR remains unclear and in flux. Through a meta-narrative review, we construct a sociohistorical map of the concep...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | SSM - Mental Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666560324000550 |
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| author | Leighton Schreyer Csilla Kalocsai Oshan Fernando Melanie Anderson Vanessa Lockwood Sophie Soklaridis Gary Remington Araba Chintoh Suze Berkhout |
| author_facet | Leighton Schreyer Csilla Kalocsai Oshan Fernando Melanie Anderson Vanessa Lockwood Sophie Soklaridis Gary Remington Araba Chintoh Suze Berkhout |
| author_sort | Leighton Schreyer |
| collection | DOAJ |
| description | Despite ongoing attempts to delineate and name treatment resistance (TR) in psychiatry, the term is increasingly deployed across diagnostic categories. Still, what it is that constitutes TR remains unclear and in flux. Through a meta-narrative review, we construct a sociohistorical map of the concept of TR as it is employed in schizophrenia (TRS) and major depressive disorders (TRD). We track debates about TR, identify underlying assumptions and influencing factors that shape how the concept has evolved over time, and consider the intended and unintended consequences of its conceptualization. We develop our findings as three unique threads that, braided together, offer insight into TR as an interactive kind. Each thread analyzes and plays with the notion of heterogeneity, which arises in the literature as both a theme and a problem to be solved. Thread one looks at prevailing controversies surrounding the definition of TR. Here, heterogeneity arises in relation to how TR is delineated. We also consider the notion of “pseudoresistance,” a novel concept that functions to manage and contain heterogeneity, defining the boundaries of TR through its exclusions. Thread two explores the range of actors whose interests and practices are coordinated to shape TR as a concept: the pharmaceutical industry, academic psychiatry, clinicians, and health systems. Each group has its own interests and orientations: a heterogenous range of actors contributing to the thing that TR is. Thread three examines the intended and unintended consequences that attempts to conceptualize TR have yielded, including a reification of the biomedical paradigm and the personification of TR. This paper offers a systematic approach to thinking about similarities, differences, particularities and tensions embedded within TR to understand the politics and possibilities of the concept. |
| format | Article |
| id | doaj-art-8dd8f014ab674bb4a16d64b87e57e7a3 |
| institution | OA Journals |
| issn | 2666-5603 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM - Mental Health |
| spelling | doaj-art-8dd8f014ab674bb4a16d64b87e57e7a32025-08-20T02:38:13ZengElsevierSSM - Mental Health2666-56032024-12-01610035010.1016/j.ssmmh.2024.100350Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative reviewLeighton Schreyer0Csilla Kalocsai1Oshan Fernando2Melanie Anderson3Vanessa Lockwood4Sophie Soklaridis5Gary Remington6Araba Chintoh7Suze Berkhout8Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Corresponding author. 200 Elizabeth Street, 8th floor, Eaton North, Toronto, ON, M5G 2C4, Canada.Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Anthropology, University of Toronto, Toronto, CanadaSunnybrook Health Sciences Centre, Toronto, CanadaUniversity Health Network, Toronto, CanadaTemerty Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Anthropology, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Foothills Medical Centre, Calgary, Canada; Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, CanadaDepartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, CanadaDepartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, CanadaFoothills Medical Centre, Calgary, Canada; Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, CanadaDepartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; University Health Network, Toronto, CanadaDespite ongoing attempts to delineate and name treatment resistance (TR) in psychiatry, the term is increasingly deployed across diagnostic categories. Still, what it is that constitutes TR remains unclear and in flux. Through a meta-narrative review, we construct a sociohistorical map of the concept of TR as it is employed in schizophrenia (TRS) and major depressive disorders (TRD). We track debates about TR, identify underlying assumptions and influencing factors that shape how the concept has evolved over time, and consider the intended and unintended consequences of its conceptualization. We develop our findings as three unique threads that, braided together, offer insight into TR as an interactive kind. Each thread analyzes and plays with the notion of heterogeneity, which arises in the literature as both a theme and a problem to be solved. Thread one looks at prevailing controversies surrounding the definition of TR. Here, heterogeneity arises in relation to how TR is delineated. We also consider the notion of “pseudoresistance,” a novel concept that functions to manage and contain heterogeneity, defining the boundaries of TR through its exclusions. Thread two explores the range of actors whose interests and practices are coordinated to shape TR as a concept: the pharmaceutical industry, academic psychiatry, clinicians, and health systems. Each group has its own interests and orientations: a heterogenous range of actors contributing to the thing that TR is. Thread three examines the intended and unintended consequences that attempts to conceptualize TR have yielded, including a reification of the biomedical paradigm and the personification of TR. This paper offers a systematic approach to thinking about similarities, differences, particularities and tensions embedded within TR to understand the politics and possibilities of the concept.http://www.sciencedirect.com/science/article/pii/S2666560324000550 |
| spellingShingle | Leighton Schreyer Csilla Kalocsai Oshan Fernando Melanie Anderson Vanessa Lockwood Sophie Soklaridis Gary Remington Araba Chintoh Suze Berkhout Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review SSM - Mental Health |
| title | Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review |
| title_full | Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review |
| title_fullStr | Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review |
| title_full_unstemmed | Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review |
| title_short | Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review |
| title_sort | treatment resistance in schizophrenia and depression as an interactive kind mapping the development of a classification through meta narrative review |
| url | http://www.sciencedirect.com/science/article/pii/S2666560324000550 |
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