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Prevalence of treatment resistance and clozapine use in early intervention services
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Stokes, Imogen, Griffiths, Siân Lowri, Jones, Rowena, Everard, Linda, Jones, Peter B., Fowler, David, Hodgekins, Joanne, Amos, Tim, Freemantle, Nick, Sharma, Vimal, Marshall, Max, Singh, Swaran P., Birchwood, Max and Upthegrove, Rachel (2020) Prevalence of treatment resistance and clozapine use in early intervention services. BJPsych Open, 6 (5). e107. doi:10.1192/bjo.2020.89 ISSN 2056-4724.
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WRAP-prevalence-treatment-resistance-clozapine-use-early-intervention-services-Singh-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (412Kb) | Preview |
Official URL: http://dx.doi.org/10.1192/bjo.2020.89
Abstract
Background:
Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
Aims:
This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.
Method:
Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.
Results:
A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.
Conclusions:
Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Schizophrenia, Schizophrenia -- Treatment, Clozapine, Psychoses, Psychoses -- Treatment | ||||||
| Journal or Publication Title: | BJPsych Open | ||||||
| Publisher: | Royal College of Psychiatrists | ||||||
| ISSN: | 2056-4724 | ||||||
| Official Date: | 17 September 2020 | ||||||
| Dates: |
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| Volume: | 6 | ||||||
| Number: | 5 | ||||||
| Article Number: | e107 | ||||||
| DOI: | 10.1192/bjo.2020.89 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 19 January 2021 | ||||||
| Date of first compliant Open Access: | 19 January 2021 | ||||||
| RIOXX Funder/Project Grant: |
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| Is Part Of: | 1 |
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