Are we making best use of clozapine? : A review of the psychopharmacological treatment pre-clozapine initiation in treatment resistant schizophrenia.

Poster A110, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Debasis Das1, Victoria Baird2; 1Leicestershire Partnership NHS Trust, UK, 2University of Leicester, UK

Introduction: Where treatment resistant schizophrenia (TRS) is established, studies suggest there should be no delay in clozapine initiation. NICE Quality standards require adults with schizophrenia who have not responded adequately to treatment with at least 2 antipsychotic drugs to be offered clozapine. Aim: To evaluate antipsychotic use and clozapine initiation in patients with treatment resistant schizophrenia in a first-episode psychosis service. Methods: Clinical records of patients on Clozapine within the Psychosis Intervention and Early Recovery (PIER) service were examined, cross-sectionally, in September 2016 to find details of previous antipsychotic prescription and their duration of use. At the time of study, PIER provided a first episode service for 14-35 year serving a total population more than 1 million. Results: Nine patient cases were identified. An average of two antipsychotics were tried (mean = 2.7) pre-clozapine initiation. Each antipsychotic was tried for around five months (mean = 5.15 months) before switching to another antipsychotic. Length of time from acceptance into the PIER service for treatment to initiation of clozapine ranged from 1 month to 36 months. The median time elapsed pre-clozapine was 14.5 months. In over half of the cases (n=5) clozapine was offered as a treatment option far earlier in the course, but for various reasons not used. Professional’s attitudes appeared to have impact upon patient decision to initiate clozapine. Conclusion and Recommendations: 1. For patients with TRS consider clozapine earlier in treatment. 2. Professional education and increased awareness amongst non-medical professionals about clozapine use should be promoted.

Topic Area: Psychopharmacology

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