Clozapine use in a Latin-American cohort of first episode psychosis
Poster A111, Monday, October%208, 11:30%20am%20-%201:00%20pm, Essex%20Ballroom
Bárbara Iruretagoyena1, Alfonso González - Valderrama2,3, Juan Undurraga2,4, Carmen Castañeda2, Carlos Gallardo2, Ruben Nachar2,3, Nicolás Crossley1,5, Cristián Mena2,6; 1Department of Psychiatry, School of Medicine. Pontificia Universidad Católica de Chile, 2Early Intervention Program, Instituto Psiquiatrico Dr. José Horwitz, 3School of Medicine, Universidad Finis Terrae, Chile, 4Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo. Santiago, Chile, 5Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London UK, 6National Unit of Clozapine Pharmacovigilance, J. Horwitz Psychiatric Institute, Santiago, Chile
Purpose : Clozapine is the first-line treatment for treatment-resistant (TR) psychosis. However, there is widespread evidence of delays in treatment initiation (average 5 years) and underutilization. Reports of clozapine use in first episode psychosis (FEP) patients are scarce. Characterizing further this population could contribute towards an earlier and more widespread use of clozapine in young patients. Methods: We performed a cross-sectional study on patients from an outpatient Early Intervention in Psychosis program in Chile. Data included sociodemographic characteristics, clozapine use (doses, time of initiation), and standardized clinical and functional status. FAST (Functional Assessment Short Test), SS-DSM5 (Symptom Severity Scale of the DSM5 for Schizophrenia), and MG (Morinsky Green Adherence Questionnaire) were applied to participants. Results:We included 83 patients (mean age 21.68 years), most with non-affective psychosis (81.23%). We used clozapine treatment as a proxy for treatment resistance. 34 patients were on clozapine treatment (41% of all sample). Compared with patients that used other antipsychotics, clozapine users had longer duration of untreated psychosis (4 vs 12 months, p < 0.05) and higher severity scores (SS-DSM5 mean 7.2 vs 10.87; p<0.01). Mean dose of clozapine was 348.57 mg (median 300 mg). Median time to initiation of clozapine was 22 months (SD 11.32) since beginning of disease and 6.43 months (SD 11.25) from start of follow up in our program. Conclusions: There was a high rate of treatment-resistance in our FEP cohort. The shorter delay in clozapine initiation and higher prescription rate found are results that needed it compared to international reports.
Topic Area: Psychopharmacology