Current clozapine treatment and prior antipsychotic prescribing

الملخص EN

Background : in most countries including the United Kingdom, Clozapine is licensed for the treatment of resistant schizophrenia, which is usually defined, according to Kane 19891 and co-workers, as failure to respond to adequate trials of 2 antipsychotics for adequate duration.

According to the BNF (British National Formulary) Clozapine should be introduced if schizophrenia is inadequately controlled despite the sequential use of two or more antipsychotics, one of which is an atypical antipsychotic, each for at least 6—8 weeks.

Method Prescribing histories were obtained from the case notes, admission and discharge summaries and prescription charts for all patients on Clozapine at Hall am Street Hospital, England, in August 2004.

Results Fifty-six patients, 35 males and 21 females, receiving Clozapine for schizophrenia or schizoaffective disorder (WHO International Classification of Diseases, ICD-10 Classification of Mental Disorders) were identified.

The mean age of patients was 37.13 years.

Forty-seven (83.9 %) patients were single, six (10.7 %) married and three (5.4 %) divorced.

Thirty-three patients (58.9 %) were Caucasian, fifteen (26.8 %) Asian and eight (14.3 %) Afro-Caribbean.

Mean duration of illness was 13.9 years.

Mean duration of Clozapine use was 4.99 years.

At some point before the commencement of Clozapine, forty-six (85.2 %) had received an atypical antipsychotics, all of whom but one for adequate duration and in adequate doses, forty-three (79.6 %) had received oral typical antipsychotic and forty-four (81.5 %) had been tried on depot antipsychotic intra-muscular injections.

All patients except two had received two adequate trials of different antipsychotics prior to the commencement of Clozapine.

The mean maximum theoretical delay in using Clozapine was 5.98 years.

Clozapine was discontinued in five patients, due to intolerable adverse effects in 4 and poor response in 1.

Conclusion : Our study shows that Clozapine treatment was quite delayed for longer than is clinically desirable.

It also indicates that, like in many other countries, Clozapine is underused in the UK as well.

This probably reflects the costs and complexities of therapy with Clozapine.