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    Prevalence of treatment resistance and clozapine use in early intervention services.

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    Authors
    Stokes, Imogen
    Griffiths, Siân L.
    Jones, Rowena
    Everard, Linda
    Jones, Peter B.
    Fowler, David
    Hodgekins, Joanne
    Amos, Tim
    Freemantle, Nick
    Sharma, Vimal
    Marshall, Max
    Singh, Swaran P.
    Birchwood, Max
    Upthegrove, Rachel
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    Publication Date
    2020-09-17
    
    Metadata
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    Abstract
    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. This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services. 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. 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. 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.
    Citation
    Stokes, I., Griffiths, S. L., Jones, R., Everard, L., Jones, P. B., Fowler, D., ... & Marshall, M. (2020). Prevalence of treatment resistance and clozapine use in early intervention services. BJPsych open, 6(5).
    Journal
    BJPsych Open
    URI
    http://hdl.handle.net/10034/623821
    DOI
    10.1192/bjo.2020.89
    Type
    article
    EISSN
    2056-4724
    ae974a485f413a2113503eed53cd6c53
    10.1192/bjo.2020.89
    Scopus Count
    Collections
    Health and Social Care

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