Patterns of Prescribing Clozapine and Other Antipsychotic for Patients with First Episode Psychosis in Early Intervention Teams

Poster B71, Friday, October 21, 11:30 am - 1:00 pm, Le Baron

Saeed Farooq1, Tongeji E Tungaraza2, Wakil Ahmed3, Chinonyelum Chira4, Erin Turner5, Susan Mayaki6, Nandhra Harpal7, Tom Edwards8; 1Research Institute for Primary Care & Health Sciences Keele University, 2Choice Lifestyles LTD, Birmingham B17 8ll, Uk;, 3Black Country NHS Foundation Trust, 4Walsall Healthcare NHS Trust, 5Birmingham and Solihull Mental Health Foundation Trust, 6Herefordshire, Mental Health Foundation Trust, 7Coventry and Warwickshire NHS Foundation Trust, 8Dudley and Walsal Mental Health Trust

We aim to describe pattern of antipsychotic use and the prescription of clozapine relative to other antipsychotics in Early Intervention Services (EIS). We extracted information from the case notes on antipsychotic use in chorological order since patients were accepted in EIS and the reasons for changing antipsychotic drugs, in six EIS teams in West Midlands, UK. We included 431 First Episode Psychosis (FEP) patients, 380 (88.2%) were still being prescribed antipsychotics. 333 (77.3%) patients were on Second Generation Antipsychotic monotherapy, 40 (9.3%) on depot medications, and 28(8.3%) on Clozapine. 108 (25%) have had a trial of more than two drugs. Symptoms control was achieved in 212 (49.2%), 194 (45%) were still experiencing positive symptoms. Having on-going symptoms was associated with being prescribed high dose (d.f.=1, P=0.003), and having tried more than two antipsychotics (Pearson X2=28.76, d.f.=2, P<0.001). Clozapine was initiated within 19.5 months of being accepted in EIS, and after trial of 1-5 antipsychotics (median, 3) before clozapine initiation. There was association of having positive symptoms and taking clozapine, (Yates X2=18.24, d.f.=1, p<0.001). This is the first study to describe the pattern of antipsychotics use in a large First episode population in UK. High proportion of monotherapy was consistent with the guidelines but low use of depot antipsychotics and Clozapine was notable considering that about 50% of patients were experiencing some psychotic symptoms and a quarter of sample had tried three or more antipsychotics. An algorithm based approach is recommended in selecting and switching antipsychotics to achieve the remission.

Topic Area: Psychopharmacology

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