Table 1.

Issues to be addressed in order to label a patient as being “refractory”

1. Correct diagnosis

2. The disorder is not secondary to an organic disorder

3. The poor response to treatment is not due to somatic or mental comorbidity

4. Poor response to treatment is not due to a somatic condition which might not constitute a disorder by itself (e.g. genetic factors, smoking, alcohol use, gender, race etc.)

5. The failure of therapy is not due to nontolerability

6. The patient complies with the recommended treatment and poor response is not a consequence of lack of adherence