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dc.contributor.authorStokes, Imogen
dc.contributor.authorGriffiths, Siân L.
dc.contributor.authorJones, Rowena
dc.contributor.authorEverard, Linda
dc.contributor.authorJones, Peter B.
dc.contributor.authorFowler, David
dc.contributor.authorHodgekins, Joanne
dc.contributor.authorAmos, Tim
dc.contributor.authorFreemantle, Nick
dc.contributor.authorSharma, Vimal
dc.contributor.authorMarshall, Max
dc.contributor.authorSingh, Swaran P.
dc.contributor.authorBirchwood, Max
dc.contributor.authorUpthegrove, Rachel
dc.date.accessioned2020-10-01T00:41:34Z
dc.date.available2020-10-01T00:41:34Z
dc.date.issued2020-09-17
dc.identifierpubmed: 32938513
dc.identifierpii: S2056472420000897
dc.identifier.citationStokes, 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).
dc.identifier.doi10.1192/bjo.2020.89
dc.identifier.urihttp://hdl.handle.net/10034/623821
dc.description.abstractTreatment 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.
dc.languageeng
dc.sourcepissn: 2056-4724
dc.subjectTreatment resistance
dc.subjectclozapine
dc.subjectearly intervention
dc.subjectearly psychosis
dc.subjectschizophrenia
dc.titlePrevalence of treatment resistance and clozapine use in early intervention services.
dc.typeArticle
dc.identifier.eissn2056-4724
dc.identifier.journalBJPsych Open
dc.date.updated2020-10-01T00:41:34Z
dc.identifier.urlhttps://www.cambridge.org/core/journals/bjpsych-open/article/prevalence-of-treatment-resistance-and-clozapine-use-in-early-intervention-services/6235C925BB24596B555A2E1A531FC818


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