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Table 1 Criteria for referral to the NPS, based on Department of Health Guidelines (DoH, 2009)

From: Skating on thin ice: pragmatic prescribing for medication refractory schizophrenia

Criteria for complex and/or refractory disorder services
Generic complex/refractory criteria Specific to a psychosis centre
Diagnostic uncertainty hampering treatment Failure to respond adequately (or tolerate) two antipsychotics (at least one atypical)
Persistently high symptom burden
Significant impact on functioning Attempted adequate trial of clozapine, usually for a minimum of 6–9 months
Persisting (>2 years) pattern of incapacity despite appropriate treatment
Multiple comorbidities increasing likelihood of chronicity Appropriate psychological therapies such as cognitive behavioural therapy and family interventions should have been attempted
Need for specialised treatments, e.g. TMS
Inpatient stay >6-12 months