Study finds that while the drug can target treatment resistant patients, its side effects are a deterrent to use.
A recent study published in the Spanish Journal of Psychiatry and Mental Health by the Psychiatry and Mental Health Research Group at the Germans Trias i Pujol Research Institute (IGTP), in collaboration with the ETEP (Study and Treatment of Psychotic Episodes) group at Hospital del Mar, sought to examine clozapine prescription use among patients diagnosed with a first psychotic episode (FEP) and the reasons behind why providers are hesitant to prescribe it despite its effectiveness in adequately treating symptoms.
Clozapine is a prescription antipsychotic drug mainly used to treat schizophrenia and is generally viewed as the drug of choice when other treatments have failed to adequately address symptoms. Schizophrenia, a serious mental health condition, impacts the way a person thinks, feels, and behaves, causing severe symptoms including hallucinations, delusions, and derealization as well as disorganized thinking. While the exact cause of the disorder’s development is unknown, it is believed to be brought on by a combination of family history, brain chemistry abnormalities, and environmental factors.
Interventions for schizophrenia generally include the use of antipsychotic medications – both oral and injectable drugs – and multifaceted psychosocial approaches focused on improving daily functioning. Symptoms can be well-managed with strict adherence to a prescribed treatment regimen. However, if patients are noncompliant or don’t have proper access to the assistance they need, they can be at high risk of harming themselves or others.
Previous research has repeatedly shown that clozapine can significantly reduce the risk of recurrent suicidal thoughts and behavior in patients with schizophrenia or schizoaffective disorder. The drug works by blocking neurotransmitter receptors in the brain, including dopamine and serotonin, which helps manage hallucinations, delusions, and disordered thought processing.
The current research aimed to determine the overall share of schizophrenic patients receiving clozapine, identify predictors for use, assess the time to drug initiation and see how the drug’s adverse effects impact initiation.
The study involved 255 patients all diagnosed with FEP with the team gathering data on clozapine prescription rates, Global Assessment of Functioning (GAF) Scale scores, and unwanted side effects. The effects they focused mainly on were sedation and metabolic changes such as increased body mass index (BMI) and triglycerides.
The study determined that there were high rates of treatment-resistant schizophrenia, specifically, among sample group and an estimated 30% hadn’t responded to more traditional antipsychotics. Yet only 78% of these patients were prescribed clozapine, and the average time it was first administered was 55 days after initial diagnosis.
The team also found a lower score on the GAF Scale was closely associated with the likelihood of clozapine being introduced within the first two years of treatment, and that the drug often led to sedation, a higher BMI and higher triglycerides. The team felt these adverse effects remain primary reason both prescribers and patients are hesitant to make the switch.
The study’s findings demonstrate that the lack of clozapine use even among treatment resistant individuals despite its ability to adequately address symptoms is likely due to concerns about adverse effects. However, turning to the drug sooner, right after a first psychotic episode, can substantially reduce psychotic symptoms over the long run. Thus, by promoting earlier introduction and addressing barriers to use, providers can significantly improve treatment outcomes and a patient’s overall quality of life.
Sources:
Clozapine use in the first two years after first-episode psychosis in a real-world clinical sample
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