Reasons for non‐prescription of clozapine in treatment‐resistant schizophrenia

Swinton, Mark; Ahmed, Adekunle G.

doi:10.1002/cbm.313

Cited by 15 publications

(34 citation statements)

References 12 publications

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“…This was replicated by Kelly et al , 18 who surveyed psychiatrists in Maryland, USA, and found that the main barrier, ranked highest on the Likert scale (1–5), was patient non-adherence with blood work (3.7 ± 1.1) and the burden of blood work on the patient (3.6 ± 1.2) 18 . In a survey of patients, Swinton and Ahmed (1999) 19 reported that almost two-thirds of participants did not want the burden of regular blood tests. This was replicated in a survey of staff, with 65% ( n = 83) reporting that patients did not want the burden of regular blood tests and that frequent blood tests were considered a major barrier to initiating clozapine 17 …”

Section: Resultsmentioning

confidence: 89%

“…However, Nielson et al (2009) found that only 44.9% ( n = 44) would go to clozapine after two antipsychotics, 13 and about a third 30.6% ( n = 30) 13 of clinicians in one survey and 14% ( n = 19) in another would wait until three adequate trials of antipsychotics prior to initiating clozapine, while 18.4% ( n = 19) 13 would wait until more than three failed adequate trials of antipsychotics. In another survey, 28% ( n = 51, total 184) of consultants said they would trial at least another antipsychotic before going to clozapine after a failed trial of two antipsychotics, 22 and 40.5% ( n = 92) preferred to use several other antipsychotics before clozapine 19 . Nielson et al 13 found that 64.7% of psychiatrists surveyed ( n = 64) would rather combine two antipsychotics than prescribe clozapine, and 15.2% ( n = 15) would augment with a mood stabiliser before using clozapine in a non-schizoaffective state 13 …”

Section: Resultsmentioning

confidence: 99%

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Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

et al. 2018

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Aims and methodTo systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review.ResultsThe major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine.Clinical implicationsIn view of consistent evidence across the studies on inadequate knowledge and skills as a significant barrier, we suggest that a certification requiring competence in initiating and managing side-effects of clozapine becomes a mandatory requirement in training programmes.Declarations of interestNone.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

et al. 2018

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“…Various explanations have been suggested , but few studies have asked practitioners who are involved in prescribing decisions directly about their reasons for non‐prescribing of clozapine. Unfamiliarity with the guidelines had been suggested as an obvious reason for non‐adherence , but here we have found that the majority of practitioners report familiarity with the guidelines, indicating this does not explain non‐adherence among practitioners in our unit.…”

Section: Discussionmentioning

confidence: 99%

“…Potential non‐compliance with oral therapy was also a concern which was identified in our study. Fears of non‐compliance have been identified previously as a barrier to prescribing , although compliance with clozapine is actually better compared with other antipsychotics . Recent data show that rehospitalisation rates for patients receiving depot medication are higher than those receiving clozapine , suggesting that the alternatives which guarantee compliance may still be worse for patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Practitioner attitudes to clozapine initiation

Gee

Vergunst

Howes³

et al. 2013

Acta Psychiatr Scand

112

129

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Professionals identified the dominant barriers to prescribing as being patient focussed - refusal of blood test monitoring or concerns about tolerability. Clinician fears about compliance or medical complications were also important. The development of out-patient services specifically tasked with initiating clozapine may help to increase the frequency of prescribing of clozapine earlier in treatment than is currently seen.

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“…Auch hier ist aber ein direkter Effekt nicht mit Sicherheit nachgewiesen. Darüber hinaus ergibt sich, wie bei allen peroral verabreichten Medikamenten, bei vielen Zielgruppen das Problem der mangelnden Einnahmezuverlässigkeit, was dadurch belegt wird, dass in englischen High Security Hospitals der Hauptgrund für die Nichtverschreibung von Clozapin mangelnde Compliance war [150]. 2.…”

Section: Introductionunclassified

Aggressives Verhalten psychisch Kranker im stationären Bereich: Häufigkeit, Risikofaktoren, Prävention

Schanda¹,

Taylor²

2001

Fortschr Neurol Psychiatr

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In contrast to Angloamerican and Scandinavian countries inpatient violence was not regarded as a problem in German-speaking countries for a long time. Only recently it has become a topic of increasing interest for clinical practice and research, whereby the present data exhibit significant parallels to the international development. After the discussion of methodological problems (e. g. varying definitions, sources of information, ways of registration) the paper presents the current state of knowledge about inpatient violence:Underestimation in general, mainly with respect to female patients; only a few patients are responsible for the majority of assaults; victims are rather staff members than fellow patients; discrepancy between the mostly minor physical, though major emotional consequences for victims; considerably negative effects on patient-staff interactions and ward climate. Aside from patient-related actuarial and dynamic risk factors (social origin, previous history of aggressive behaviour, dissocial personality traits and - partly - diagnoses, acute intoxication, substance abuse, lack of insight and compliance, psychotic symptoms) external/contextual factors as patient-staff ratio, ward size, structure and climate, staff-attitudes, recognition of early warning signs and handling of risk situations are of major importance for the frequency and severity of incidents. Intervention and prevention strategies are focussing - aside from medication - on the aforementioned staff-related factors and patient-staff interactions. They are the principal basis for sufficient inpatient treatment beyond the problem of violence.

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Reasons for non‐prescription of clozapine in treatment‐resistant schizophrenia

Abstract: ABSTRACT

Cited by 15 publications

References 12 publications

Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

Practitioner attitudes to clozapine initiation

Aggressives Verhalten psychisch Kranker im stationären Bereich: Häufigkeit, Risikofaktoren, Prävention

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