Treatment resistance in schizophrenia and depression as an interactive kind: Mapping the development of a classification through Meta-Narrative review
Bibliographic record
Abstract
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. • Meta-Narrative review is a valuable methodology for synthesizing disparate ideas. • Definitions of Treatment Resistance (TR) in psychiatry are highly variable. • The heterogeneity of TR is reflective of its ontological multiplicity. • Definitions of TR reflect multiple interests and perspectives from different actors. • There are intended and unintended consequences of trying to conceptualize TR.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".