Prior Antipsychotic Prescribing in Patients Currently Receiving Clozapine: A Case Note Review
J Clin Psychiatry 2003;64(1):30-34
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clozapine is indicated for the
treatment of resistant schizophrenia, which is usually defined as
failure to respond to adequate trials of 2 antipsychotics. It is
thought that only clozapine is likely to be effective in such
cases and that other drugs are ineffective. We sought to discover
prior patterns of antipsychotic prescribing in schizophrenic
patients eventually prescribed clozapine.
Method: Prescribing histories were obtained from
prescription charts and case notes for all inpatients prescribed
clozapine in 4 hospitals in southeast London during April 2001.
Results: 120 patients were identified, of whom
112 had been diagnosed with schizophrenia or schizoaffective
disorder and whose data were analyzed. The mean duration of
illness was 15.1 years. Subjects had experienced a mean of 9.2
(range, 2-35) episodes of antipsychotic prescription before
clozapine was first used, with 5.7 (range, 0-25) episodes
constituting adequate trials (drug used at therapeutic dose for 6
weeks). The mean number of different antipsychotics used was 5.5
(range, 1-13), with a mean of 4.0 (range, 0-12) given an adequate
trial. Ninety percent of patients (N=101) had received an
atypical antipsychotic before first use of clozapine, and 65%
(N=73) had previously received antipsychotic polypharmacy. The
mean maximum theoretical delay in using clozapine was 5.0 years
(range, 0-11.1 years). Longer delay was significantly (p < .05) associated with being aged over 30 years at the time of the study, being diagnosed with psychotic illness before the introduction of clozapine, and completing adequate trials of 2 different antipsychotics before the introduction of clozapine or risperidone.
Conclusion: Clozapine treatment was quite likely
delayed for longer than is clinically desirable. This delay may
have important effects on quality of life, clinical outcome, and
health resource utilization.