Effectiveness of Clozapine on Employment Outcomes in Treatment-Resistant Schizophrenia: A Retrospective Bidirectional Mirror-Image Study

Abstract

Purpose Clozapine is more effective than other antipsychotics and is the only antipsychotic approved for treatment-resistant schizophrenia. The objective of this study is to reveal the effect of clozapine on employment using a bidirectional mirror-image model. Patients and Methods This design was a retrospective observational study that investigated the employment status of patients with treatment-resistant schizophrenia based on medical records. The bidirectional mirror-image model consisted of 1) switching from other antipsychotics to clozapine and 2) switching from clozapine to other antipsychotics. The observation period was 1 year for each pre- and post-clozapine initiation and discontinuation. Results We included 36 patients in the bidirectional mirror-image model. The regular employment plus employment support rate was significantly higher in the clozapine phase than in the other antipsychotic phase in the bidirectional mirror-image model (30.6% vs 11.1%, P = 0.039). The days of regular employment plus employment support were also significantly longer in the clozapine phase (61.3 ± 106.2 vs 24.7 ± 82.7 days, P = 0.032). As per the unidirectional mirror-image model, switching to clozapine resulted in significantly higher regular employment plus employment support rates in the clozapine phase than those in the other antipsychotic phase (33.3% vs 10.0%, P = 0.039). Switching from clozapine to other antipsychotics did not exhibit significant differences in any outcomes. Conclusion The results suggest that clozapine is superior to other antipsychotics with respect to achieving employment in patients with treatment-resistant schizophrenia. However, biases specific to the mirror-image model need to be considered.

The New Horizon of Antipsychotics beyond the Classic Dopaminergic Hypothesis—The Case of the Xanomeline–Trospium Combination: A Systematic Review

“…All the available antipsychotics for clinical use, including pimavanserin, which was recently approved by the U.S. Food and Drug Administration (FDA) only for the management of hallucinations and delusions associated with Parkinson's disease, are based on the dopaminergic hypothesis of psychosis [16][17][18][19][20][21]. Despite more than 60 years of research, only one medication, clozapine, has been approved for treatment-resistant cases of schizophrenia (TRS) [22][23][24]. Additionally, there are some patients who do not respond to clozapine and are classified as clozapine-resistant or "ultratreatment-resistant" cases [25].…”

The New Horizon of Antipsychotics beyond the Classic Dopaminergic Hypothesis—The Case of the Xanomeline-Trospium Combination: A Systematic Review

“…All the available antipsychotics for clinical use, including pimavanserin, which was recently approved by the U.S. Food and Drug Administration (FDA) only for the management of hallucinations and delusions associated with Parkinson's disease, are based on the dopaminergic hypothesis of psychosis [16][17][18][19][20][21]. Despite more than 60 years of research, only one medication, clozapine, has been approved for treatment-resistant cases of schizophrenia (TRS) [22][23][24]. Additionally, there are some patients who do not respond to clozapine and are classified as clozapine-resistant or "ultra-treatment-resistant" cases [25].…”