Treatment-resistant schizophrenia

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Target exams

Red flags

• Active suicidal intent, plan, or recent attempt in a patient labelled TRS — escalate care intensity; clozapine has anti-suicide evidence in high-risk schizophrenia and is not a slow optional luxury
• Command hallucinations with compliance risk, severe paranoia driving violence, catatonia, or dangerous self-neglect — risk management first, not another incomplete oral trial
• Pseudo-resistance mislabelled as TRS: non-adherence, under-dosing, substances, or organic psychosis — LAI and levels before the TRS stamp
• Clozapine without monitoring infrastructure — no bloods, no drug; myocarditis window (fever, tachycardia, chest pain early); constipation progressing to ileus
• Declaring clozapine failure without adequate dose, duration, plasma level, and adherence check
• Years of polypharmacy while delaying a TRRIP-guided clozapine offer