Marc-André Roy1,2,3, Marie-France Demers2,3,4, Candice Crocker3,5, Nicola Banks3,6, Richard Williams3,7, Andrea Bardell3,7, Phil Tibbo3,5; 1Département de Psychiatrie et Neurosciences, Faculté de Médecine, Université Laval, Québec, PQ, Canada, 2CNDV/IUSMQ/CIUSSS-CN, Québec, PQ, Canada, 3Canadian Consortium for Early Intervention in Psychosis, 4Faculté de Pharmacie, Université Laval, Québec, PQ, Canada, 5Dalhousie University, Halifax, NS, Canada, 6Myelin, Toronto, ON, Canada, 7University of Victoria, Victoria, BC, Canada
To assess the impact of Clozapine in Early-Intervention Programs (EIP), we retrospectively reviewed the charts of 147 patients with a schizophrenia spectrum psychotic disorder consecutively admitted to either of 3 EIP. Subjects aged 18-30 had been followed for ≥3 years. We collected, for each antipsychotic trial, dosage, duration of trial and adherence, and CGI-S once the medication was judged optimal. 115/147 patients (78%) reached full remission (CGI-S ≤3) during the chart review interval. 29/147 (19.7%) were exposed to clozapine, after a mean of 2.89 antipsychotic trials; Clozapine was initiated on an outpatient setting in 55% of cases. Total remission was reached for 20/29 (69%) Clozapine patients and partial remission (CGI-S = 4) in 9/29 (31%). More clozapine exposed patients, in comparison to the others, were on community treatment order (41 vs 28%, respectively); had comorbid substance use disorder (83 vs 64%) or personality disorder (21 vs 6%). Besides treatment resistance, other reasons to prescribe Clozapine included prior EPS (6/29), substance use disorder (9/29), suicide or violence risk (4 for each). Among unremitted patients not on Clozapine, reasons not to prescribe clozapine were insufficient severity of symptoms (n=5), expectations of severe adherence problems (n=8), major substance use disorders (n=6). Interestingly, in a single case was patient’s refusal identified as a cause for not using Clozapine. Keeping in mind its limitations, this chart audit confirms that response rates to Clozapine may be particularly high in this population and it can be in some instances successfully used patients with a typical non-adherent profile.
