Ultra-low dose clozapine treatment for people with early psychosis: Development of tailored treatment guidelines.
Poster B74, Friday, October 21, 11:30 am - 1:00 pm, Le Baron
Douglas Noordsy1, Hera Ashfaq2,3, Jacob Ballon1; 1Stanford University School of Medicine, 2Department of Psychiatry, Dartmouth-Hitchcock Medical Center, 3Child Study Center, Yale School of Medicine
People in early psychosis who are not responding to antipsychotic medications may benefit from clozapine treatment. However, titration, dosing and serum level guidelines for clozapine are based on treatment of people in tertiary stages of schizophrenia. Given the tolerability challenges of clozapine and evidence that people in early psychosis are more sensitive to antipsychotic effects, we developed a slow titration approach to clozapine initiation. In this presentation we outline the evolution of this approach and present data from a case series treated following guidelines tailored to the needs of people in early psychosis. Clozapine was started in doses of 6.75-25 mg daily with titration on a weekly basis in 6.75-25 mg increments. We sought the lowest dose possible associated with clinical response, and targeted a maintenance dose of 75-125 mg daily. Data were collected by chart review. We used the Clinical Global Impression scale (CGI) to retrospectively rate severity, improvement and efficacy index from progress notes at baseline, approximately 3-months & 12-months into clozapine treatment, and from the last available visit. The CGI efficacy index incorporates therapeutic effect and side effect burden. We will report demographics, diagnosis, duration of illness, titration schedule, maintenance dose, clozapine serum levels when available, weight, CGI-Severity, Improvement and efficacy index ratings, duration of clozapine treatment and continuation status for a case series of 12 patients treated. We will present a formal guideline for treatment of people with early psychosis with clozapine based on this work, and an agenda for testing and refining the guideline.
Topic Area: Psychopharmacology