Psychiatrists’ attitude towards and knowledge of clozapine treatment

Abstract

Clozapine is, in most countries, underutilized and the initiation of clozapine is often delayed. The purpose of this study is to investigate the reasons for the delay and the underutilization of clozapine. One hundred psychiatrists were interviewed by phone. The interview was a structured interview with questions regarding attitude to, knowledge of and experiences with clozapine. Forty-eight (48%) psychiatrists had treatment responsibility of fewer than five patients treated with clozapine and 31 of the interviewed psychiatrists (31%) had started clozapine within the last 3 months. Seven psychiatrists (7%) had never prescribed clozapine despite the fact that they had been working more than five years in general psychiatry. Sixty-four psychiatrists (64%) would rather combine two antipsychotics than use clozapine. Sixty-six psychiatrists (66%) believed that patients treated with clozapine were less satisfied with their treatment when compared with those treated with other atypical antipsychotics. Many psychiatrists are reluctant to use clozapine and this might be due to less experience and knowledge of clozapine. A reason for the low awareness of clozapine's properties might be that clozapine is now a generic drug, and therefore, the marketing and education in using the drug is sparse.

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

“…In contrast, the situation for clozapine use differs because it is indicated for treatment-resistant schizophrenia and reserved for the most severely ill, refractory patients (Nielsen et al, 2009;Taylor et al, 2003), which can affect the risk for diabetes through perhaps even poorer healthy lifestyle behaviors than is common in schizophrenia patients in general (Sharpe et al, 2006). Furthermore, the superior efficacy of clozapine in treatment refractory patients (Kane et al, 1988) indicates that the increased diabetes risk has to be balanced with the chance for enhanced efficacy.…”

Prescribing of Clozapine and Antipsychotic Polypharmacy for Schizophrenia in a Large Medicaid Program

“…Although we were not able to directly measure the prevalence of treatmentresistant schizophrenia in our data, the low prevalence of clozapine prescribing in our sample (only 7% of the patients) is a potential signal of underuse of clozapine, a persistent quality concern in schizophrenia care (34). Prescribers' reluctance to prescribe clozapine might stem from concerns over its safety (for example, agranulocytosis and metabolic risk), lack of knowledge or experience, or higher administrative burden associated with the monitoring program (13)(14)(15)35). Although prescribers ought to weigh safety concerns against the potential benefit of any drug, prescribers tend to overestimate the prevalence of side effects and risks associated with clozapine (14,34) and may not be aware that the incidence and lethality of agranulocytosis have been dramatically reduced by the monitoring program (36).…”

“…Despite these recommendations, rates of clozapine use have remained low in the United States, ranging between 2% and 10% (11,12). Although contraindications related to clozapine's health risks and patients' resistance related to the mandatory blood monitoring may explain a portion of the underuse, providers' resistance toward prescribing clozapine is a likely driver of underuse (13)(14)(15)(16).…”

Evaluating outcomes in an adult inpatient psychiatric rehabilitation unit

“…16,24 Possible reasons for this include clinicianrelated (negative attitudes/beliefs and lack of experience), and patient-related factors (poor compliance and refusal). 24,25 In contrast to less favourable outcome predictors, predictors of a positive outcome include psychiatric rehabilitation admission within the first 10 years of psychotic illness that suggests that earlier engagement, or the patient who is willing to engage early, is likely to have a more positive outcome. 14,15 A proportion of our patients (13% female and 30% male) were in their first episode of illness, a factor that may have contributed positively to outcomes in terms of successful 'move on' to the community.…”