Impact of clozapine on disability and course of illness in patients with schizophrenia: A study from North India

Abstract

Aim: The aim of this study was to evaluate the impact of long-term use of clozapine on disability and course of illness among patients with treatment-resistant schizophrenia. Materials and Methods: 102 participants who have been receiving clozapine for a mean duration of 5 years were evaluated on Positive and Negative Syndrome Scale (PANSS) rating, Clinical Global Impression (CGI) severity rating, and Indian Disability Evaluation and Assessment Scale (IDEAS) and the scores were compared with the scores on the same scales at the time of starting clozapine. Results: There was a significant reduction in both CGI-severity scores and scores in all the four domains of IDEAS, alongside a significant reduction on all three subscales of PANSS with clozapine treatment. The CGI global improvement subscale was rated as very much improved for 80 patients. In terms of course of symptoms, at 6 months of clozapine use, three-fourth of the patients were rated as having partial recovery with no relapse of symptoms, but with passage of time, the proportion of patients in the category of “complete recovery” was found to be increasing. Higher CGI severity at the follow-up, lower CGI global improvement, and poorer efficacy index were associated with higher disability at the follow-up. Conclusions: The present study suggests that clozapine has a significant beneficial impact on disability and course of illness among patients with treatment-resistant schizophrenia.

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

“… 16 Two other studies reported a trend toward higher rates of regular occupational activity with an increasing duration of clozapine treatment, 21 as well as improved occupational functioning score. 22 Although this study is similarly a small observational study, our findings support previously reported results through a different study design using a mirror-image model.…”

Prevalence of Functional Disability and Associated Factors Among the Patients With Schizophrenia Attending Psychiatry Outpatient Clinics at Muhimbili National Hospital, Dar Es Salaam, Tanzania. Cross-sectional Survey

“…This study is in line with a study by Fujimaki and colleagues in Japan (2012) which reported good functioning among the participants using atypical antipsychotics (51) showing the potentiality of atypical antipsychotics in reserving and improving functioning. The study of individual antipsychotics speci cally clozapine, a mother atypical antipsychotic has shown functional recovery better than counterparts and lowering refractory schizophrenia states while maintaining clinical symptoms-free states of the patients as reported in an Indian study (50). Schizophrenia refractoriness is associated with poor treatment outcomes such as poor functioning, where controlling relapses aids in modifying the outcomes as reported by Portela and colleagues in Brazil (2017), they found that atypical antipsychotics were a protective factor against readmissions and relapses and so coinciding with the nding of the current study ndings (52).…”

“…The occurrence of functional disability have linearity with extremes of age at onset among the patients with schizophrenia, such that longitudinal and snapshot studies in different countries both western and African, shows increased odds up to ve times of disability among patents with age of onset at age less than 18 years or above 60years compared to comparison groups(16, [37][38][39][40][41]. The longer duration of illness (24,28,(36)(37)(38), comorbid substance use (41,42,44), and use of conventional antipsychotics (7,11,19,49,50) are among the variables studied worldwide except in Tanzania and found to be associated with increased odds of functional disability compared to short duration illness, patients, not using any substance and those using new generation antipsychotics. Also, the contemporary care of the patients with schizophrenia, advocate parallel psychotherapy integration in care, where, up to 80% of patients are set free from functional disability (WHO, 2001).…”

What is the extent of research assessing patients’ and clinicians’ perspectives on clozapine treatment? – a comprehensive scoping review

“…No other published studies within the identified under-prioritized areas were found. Instead, eight additional studies on general clinician perspectives on clozapine treatment 203–210 , three additional studies on clozapine-patients’ (and their clinicians’) attitudes towards their ongoing treatment 40 211 212 , and three additional studies on case-note derived reasons for clozapine cessation or withholding 213–215 appeared, ratifying the repetitive behavior of current research and the importance of disseminating these results in order to direct future research towards more meaningful and less well-described areas.…”