Prevalence of treatment resistance and clozapine use in early intervention services

Imogen Stokes, Siân Lowri Griffiths, Rowena Jones, Linda Everard, Peter B Jones, David Fowler, Joanne Hodgekins, Tim Amos, Nick Freemantle, Vimal Sharma, Max Marshall, Swaran P Singh, Max Birchwood, Rachel Upthegrove

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Abstract

BACKGROUND: Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.

AIMS: This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.

METHOD: Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.

RESULTS: A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.

CONCLUSIONS: Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.

Original languageEnglish
Article numbere107
JournalBritish Journal of Psychiatry Open
Volume6
Issue number5
DOIs
Publication statusPublished - 17 Sept 2020

Keywords

  • Treatment resistance
  • schizophrenia
  • clozapine
  • early psychosis
  • early intervention

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