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Prevalence of treatment resistance and clozapine use in early intervention services

  • Imogen Stokes (a1), Siân Lowri Griffiths (a2), Rowena Jones (a3), Linda Everard (a4), Peter B. Jones (a5), David Fowler (a6), Joanne Hodgekins (a7), Tim Amos (a8), Nick Freemantle (a9), Vimal Sharma (a10), Max Marshall (a11), Swaran P. Singh (a12), Max Birchwood (a13) and Rachel Upthegrove (a14)...

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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Dr Siân Lowri Griffiths. Email: s.l.griffiths@bham.ac.uk

Footnotes

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Joint first authorship.

Joint senior authorship.

Footnotes

References

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Prevalence of treatment resistance and clozapine use in early intervention services

  • Imogen Stokes (a1), Siân Lowri Griffiths (a2), Rowena Jones (a3), Linda Everard (a4), Peter B. Jones (a5), David Fowler (a6), Joanne Hodgekins (a7), Tim Amos (a8), Nick Freemantle (a9), Vimal Sharma (a10), Max Marshall (a11), Swaran P. Singh (a12), Max Birchwood (a13) and Rachel Upthegrove (a14)...

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