Patterns of clozapine prescribing in a mental health service in New Zealand

Harrison, Jeff; Janlöv, Minna; Wheeler, Amanda

doi:10.1007/s11096-010-9398-5

Cited by 36 publications

(37 citation statements)

References 28 publications

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“…The use of clozapine varies enormously according to different countries and settings, with higher prescription rates in China 26 and Oceania 27 and lower in North America 28,29 . The rates of clozapine prescription for TRS patients found in Brazilian community centers were similar to rates found in studies carried out in the United States 28,29 , an especially low proportion when compared to other countries 26,27,30 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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Background: Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective: To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods: A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients' clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results: Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion: As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

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Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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“…However, studies indicate that adherence to this guideline is low (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Increasingly, longterm use of two or more regularly scheduled antipsychotics (polypharmacy) is prescribed, often before clozapine (11,15,(17)(18)(19)(23)(24)(25).…”

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confidence: 99%

“…Increasingly, longterm use of two or more regularly scheduled antipsychotics (polypharmacy) is prescribed, often before clozapine (11,15,(17)(18)(19)(23)(24)(25). This practice is inconsistent with evidence-based guidelines, which do not endorse long-term antipsychotic polypharmacy and recommend it only as a last-line treatment when clozapine has failed (6-10).…”

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confidence: 99%

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Antipsychotic Prescribing Pathways, Polypharmacy, and Clozapine Use in Treatment of Schizophrenia

Gören¹,

Meterko²,

Williams³

et al. 2013

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“…In certain cases of non-response to clozapine, the use of other second-generation antipsychotics, augmentation strategies with antidepressants and/or mood stabilizers, combination of antipsychotics and electroconvulsive therapy have been suggested as treatment alternatives, however, with limited evidence for their efficacy [2,[21][22][23]. Despite this, it was reported that clinicians do often try other approaches before clozapine prescription and there could be long delays before prescription of clozapine [24,25]. In the present study, only 48.3% of the patients with TRS were reported to be currently on clozapine, which shows that majority of clinicians avoided prescribing clozapine despite the guidelines.…”

Section: Discussionmentioning

confidence: 99%

Prescribing trends in treatment-resistant schizophrenia

Görmez

Kurtulmuş

Can

2017

Psychiatry and Clinical Psychopharmacology

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Objectives: Schizophrenia is a common mental health condition associated with significant morbidity and excess early mortality. Treatment-resistant schizophrenia (TRS) occurs in about one in three patients diagnosed with schizophrenia. The aim of this study was to identify attitudes of a nationally representative sample of psychiatrists towards pharmacotherapy of patients with TRS, the potential factors related to their choice of various regimens, and to investigate the clinical outcomes of different methods employed. Methods: Psychiatrists were contacted through national e-groups and various psychiatry conventions. They provided information about their professional and demographic characteristics. They were asked to describe clinical and demographic characteristics of an adult patient with TRS under their care for at least 3 months. They reported on the medication change they made and the effect of this intervention on the positive symptoms and functioning of the patient. Results: Among the 207 patients reported on, only 28.7% were on monotherapy for TRS immediately before the change in medication. With the change made in treatment regime, 40.1% were switched to a different antipsychotic agent as monotherapy, 40.6% received combination therapy with two or more antipsychotic agents, 1.4% received high-dose antipsychotics, and 4.8% had augmentation with antidepressants or mood stabilizers. 13.1% psychiatrists employed more than one method. Of the whole sample, 48.3% were put on clozapine either as monotherapy or with other medications. The monotherapy and combination groups were compared in terms of characteristics of patients and prescribers, which revealed no significant difference (p > .05). There was also no difference found on the outcome variables of two groups (p > .05). Conclusions: Although polypharmacy was found to be a common practice, there seemed to be a comparably good ratio of clozapine utilization and of attempts of switching to monotherapy among the prescribers. There were no significant patient-or prescriber-related factors in relation to preference of treatment regimens, which need further investigation on larger samples. ARTICLE HISTORY

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Patterns of clozapine prescribing in a mental health service in New Zealand

Cited by 36 publications

References 28 publications

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Antipsychotic Prescribing Pathways, Polypharmacy, and Clozapine Use in Treatment of Schizophrenia

Prescribing trends in treatment-resistant schizophrenia

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