Schizophrenia remains one of the most challenging illnesses to treat. Antipsychotic medications have revolutionized the management of this illness and helped millions of people to live more normal lives. However, a substantial proportion of individuals derive insufficient benefit from most routinely used medications.
Estimates suggest that 10-15% of those experiencing their very first episode of illness will be considered “treatment resistant” based on experiencing little improvement in symptoms following two or even three trials of standard medications. Among patients with more chronic illness, the proportion of treatment resistant patients is much higher, with estimates ranging as high as 30%.
There are no universally accepted definitions of treatment resistance, although for the present purposes, I will rely on the indications promulgated for clozapine use by the American Psychiatric Association (APA). The APA suggests “strong consideration” if psychotic symptoms are persistent after two adequate trials of antipsychotic drugs.
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http://www.psychiatryadvisor.com/the-underuse-of-clozapine-in-schizophrenia/article/409292/