An audit of time to Clozapine in First Episode Psychosis

Poster B69, Friday, October 21, 11:30 am - 1:00 pm, Le Baron

Roisin Doyle1, Donal O'Keeffe1,2, Caragh Behan1, Sarah Masterson1, Aine Kelly3, Ann Sheridan4, Dolores Keating5, Caroline Hynes5, Kevin Madigan6, Elizabeth Lawlor1, Mary Clarke1,7; 1Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland, 2School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland, 3Research Department, Saint John of God Hospitaller Ministries, Stillorgan, Co. Dublin, Ireland, 4School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland, 5Pharmacy Department, Saint John of God Hospital Limited, Stillorgan, Co. Dublin, Ireland, 6Saint John of God Community Mental Health Services Limited, Co. Dublin, Ireland, 7School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland

Purpose: For approximately one third of individuals treated for psychosis or schizophrenia, anti-psychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia and studies have demonstrated its superior efficacy in reducing psychotic symptoms. Materials and Methods: Data were collected from the medical records of people who originally presented with a first episode psychosis between 1995 and 1999 (N=171). Data was obtained from first presentation to the 31 December 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit. Results: 16.37% (n=28) of the cohort were prescribed Clozapine. Data was available for 24. Of this Clozapine subsample the mean age at baseline was 23.11 (SD=4.58); 82.14% (n=23) were male; and 82.14% (n=23) had a baseline diagnosis of schizophrenia. The mean time to first trial of Clozapine was 6.7 years. The mean number of anti-psychotics prescribed before Clozapine trial was 4.85. Following the initiation of Clozapine, the mean number of hospital admissions reduced from 6.04 per year, to 0.88 per year. Conclusion: Nearly one in five of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. Data points to the presence of barriers to Clozapine prescribing. The use of Clozapine for treatment-resistant schizophrenia is underutilised. A better understanding of the barriers to Clozapine use may improve recovery outcomes in first presentation psychosis.

Topic Area: Psychopharmacology

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