Schizophrenia is a chronic, severe mental illness characterized by psychotic symptoms such as hallucinations and delusions, often coupled with cognitive and social impairments.

 

Dopamine D2 receptor antagonists and partial agonists are the mainstay of treatment of schizophrenia. However, approximately thirty percent of patients with schizophrenia do not respond to first-line antipsychotic treatments, a condition referred to as treatment-resistant schizophrenia (TRS). Notably, the majority of patients classified with TRS fail to show any response to antipsychotics from the onset of their treatment, leading to the implication that TRS potentially involves a distinct pathophysiology compared to its non-TRS counterpart.

The introduction of neuroimaging techniques enabled the investigation into the living brain of patients with schizophrenia. Advances in these methods have provided substantial evidence regarding the pathophysiology of schizophrenia, particularly the dysregulated dopamine system. However, research on TRS remains in its early stages. In this context, I’m going to discuss both the potential applications of magnetic resonance imaging and the challenges that must be addressed in future studies of the pathophysiology of TRS.