Prevalence of treatment resistance and clozapine use in early intervention services

Stokes, Imogen, Griffiths, Siân Lowri, Jones, Rowena, Everard, Linda, Jones, Peter B., Fowler, David, Hodgekins, Joanne ORCID: https://orcid.org/0000-0003-4124-854X, 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). ISSN 2056-4724

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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:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health)
Depositing User:	LivePure Connector
Date Deposited:	05 Oct 2020 23:59
Last Modified:	01 Nov 2026 06:27
URI:	https://ueaeprints.uea.ac.uk/id/eprint/77125
DOI:	10.1192/bjo.2020.89

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