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Clozapine prescribing during follow-up of a first-episode psychosis cohort

Published online by Cambridge University Press:  13 August 2021

R. Rowntree ,
F. Fanning ,
D. Keating ,
S. Murray ,
A. Szigeti ,
R. Doyle ,
S. Mcwilliams  and
M. Clarke
R. Rowntree*
Affiliation:
Detect, St John of God Community Services, Dublin, Ireland
F. Fanning
Affiliation:
Detect, St John of God Community Services, Dublin, Ireland
D. Keating
Affiliation:
Pharmacy, St John of God Hospitaller Services, Dublin, Ireland
S. Murray
Affiliation:
Psychiatry, St John of God Hospitaller Services, Dublin, Ireland
A. Szigeti
Affiliation:
Detect, St John of God Community Services, Dublin, Ireland
R. Doyle
Affiliation:
Detect, St John of God Community Services, Dublin, Ireland
S. Mcwilliams
Affiliation:
Psychiatry, St John of God Hospitaller Services, Dublin, Ireland
M. Clarke
Affiliation:
Detect, St John of God Community Services, Dublin, Ireland
*
*Corresponding author.

Abstract

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Introduction

Of those with schizophrenia, one third develop treatment-resistant illness. Nearly 60% of these benefit from clozapine- the only antipsychotic medication licensed in this group.

Objectives

As treatment-resistant illness developed in the follow-up of a first-episode psychosis (FEP) cohort, clozapine was prescribed. This study retrospectively compared the clozapine prescribing patterns, within this cohort, to National Institute for Health and Care Excellence (NICE) guidelines. In addition, impact on hospitalisation, physical health monitoring and augmentation strategies employed following clozapine initiation were examined. Factors delaying initiation of clozapine treatment or contributing to its discontinuation were also explored.

Methods

The study included 339 individuals resident within an Irish community mental health team catchment area, referred with FEP from 1 January 2005 to 31 August 2016. Data were extracted from electronic medical records.

Results

Within the cohort, clozapine was prescribed to 32 individuals (9.4%). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). Following initiation of clozapine, mean hospital admissions per year fell from 2.3 to 0.3 (p=0.00). Mean inpatient days pre- and post-clozapine also decreased (147 vs. 53; p=0.00). In all, 18 patients ceased use of clozapine, 5 temporarily and 13 permanently.

Conclusions

Patients are being prescribed clozapine earlier than previously demonstrated. However, delayed treatment remains common, and many patients discontinue clozapine. Further research is necessary to describe and address factors which contribute to its discontinuation.

Disclosure

No significant relationships.

Keywords

first-episode psychosispsychosistreatment-resistant schizophreniaclozapine
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S803
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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