Prevalence of treatment resistance and clozapine use in early intervention services
BackgroundTreatment 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.AimsT...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2020-09-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472420000897/type/journal_article |
| _version_ | 1811157001327083520 |
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| author | Imogen Stokes Siân Lowri Griffiths Rowena Jones Linda Everard Peter B. Jones David Fowler Joanne Hodgekins Tim Amos Nick Freemantle Vimal Sharma Max Marshall Swaran P. Singh Max Birchwood Rachel Upthegrove |
| author_facet | Imogen Stokes Siân Lowri Griffiths Rowena Jones Linda Everard Peter B. Jones David Fowler Joanne Hodgekins Tim Amos Nick Freemantle Vimal Sharma Max Marshall Swaran P. Singh Max Birchwood Rachel Upthegrove |
| author_sort | Imogen Stokes |
| collection | DOAJ |
| description | BackgroundTreatment 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.AimsThis paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.MethodData 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.ResultsA 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.ConclusionsPrevalent 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. |
| first_indexed | 2024-04-10T04:59:01Z |
| format | Article |
| id | doaj.art-4e169cfece2d4d9094e6a3b67e458d07 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:59:01Z |
| publishDate | 2020-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-4e169cfece2d4d9094e6a3b67e458d072023-03-09T12:29:04ZengCambridge University PressBJPsych Open2056-47242020-09-01610.1192/bjo.2020.89Prevalence of treatment resistance and clozapine use in early intervention servicesImogen Stokes0Siân Lowri Griffiths1https://orcid.org/0000-0003-0031-7174Rowena Jones2Linda Everard3Peter B. Jones4David Fowler5Joanne Hodgekins6Tim Amos7Nick Freemantle8Vimal Sharma9Max Marshall10Swaran P. Singh11Max Birchwood12Rachel Upthegrove13https://orcid.org/0000-0001-8204-5103Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, UKSchool of Psychology, Institute for Mental Health, University of Birmingham, UKSchool of Psychology, Institute for Mental Health, University of Birmingham; and Research and Innovation, Birmingham and Solihull Mental Health Foundation Trust, UKResearch and Innovation, Birmingham and Solihull Mental Health Foundation Trust, UKUniversity of Cambridge, UKDepartment of Psychology, University of Sussex, UKNorwich Medical School, University of East Anglia, UKUniversity of Bristol, UKInstitute of Clinical Trials & Methodology, University College London, UKFaculty of Health and Social Care, University of Chester, UKLancashire Care NHS Foundation Trust, UKBirmingham Early Intervention Service, Birmingham Women's and Children's NHS Trust, UKUniversity of Warwick, UKBirmingham Medical School, College of Medical and Dental Sciences, University of Birmingham; School of Psychology, Institute for Mental Health, University of Birmingham; Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Trust, UKBackgroundTreatment 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.AimsThis paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.MethodData 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.ResultsA 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.ConclusionsPrevalent 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.https://www.cambridge.org/core/product/identifier/S2056472420000897/type/journal_articleTreatment resistanceschizophreniaclozapineearly psychosisearly intervention |
| spellingShingle | Imogen Stokes Siân Lowri Griffiths Rowena Jones Linda Everard Peter B. Jones David Fowler Joanne Hodgekins Tim Amos Nick Freemantle Vimal Sharma Max Marshall Swaran P. Singh Max Birchwood Rachel Upthegrove Prevalence of treatment resistance and clozapine use in early intervention services BJPsych Open Treatment resistance schizophrenia clozapine early psychosis early intervention |
| title | Prevalence of treatment resistance and clozapine use in early intervention services |
| title_full | Prevalence of treatment resistance and clozapine use in early intervention services |
| title_fullStr | Prevalence of treatment resistance and clozapine use in early intervention services |
| title_full_unstemmed | Prevalence of treatment resistance and clozapine use in early intervention services |
| title_short | Prevalence of treatment resistance and clozapine use in early intervention services |
| title_sort | prevalence of treatment resistance and clozapine use in early intervention services |
| topic | Treatment resistance schizophrenia clozapine early psychosis early intervention |
| url | https://www.cambridge.org/core/product/identifier/S2056472420000897/type/journal_article |
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