Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation.

Journal article

BACKGROUND: Clozapine is the only antipsychotic drug licensed for treatment-resistant schizophrenia but its use is often delayed. Since previous studies, national guidelines on the use of clozapine and other antipsychotics have been disseminated to clinicians. AIMS: To determine the theoretical delay to clozapine initiation and to quantify the prior use of antipsychotic polypharmacy and high-dose antipsychotic treatment. METHOD: Clinico-demographic data were extracted from the treatment records of all patients commencing clozapine in our centre between 2006 and 2010. RESULTS: Complete records were available for 149 patients. The mean theoretical delay in initiating clozapine was 47.7 months (s.d. = 49.7). Before commencing clozapine, antipsychotic polypharmacy and high-dose treatment was evident in 36.2 and 34.2% of patients respectively. Theoretical delay was related to illness duration (β = 0.7, P<0.001) but did not differ by gender or ethnicity. CONCLUSIONS: Substantial delays to clozapine initiation remain and antipsychotic polypharmacy and high doses are commonly used prior to clozapine, despite treatment guidelines.

Authors: Howes, O; Vergunst, F; Gee, S; McGuire, P; Kapur, S

• Journal: British journal of psychiatry : the journal of mental science
• Volume: 201
• Issue: 6
• Pages: 481-485
• Publication date: 2012-12-01
• DOI: 10.1192/bjp.bp.111.105833
• EISSN: 1472-1465
• ISSN: 0007-1250
• Language: English
• Keywords: Humans; Drug Resistance; Drug Substitution; Practice Guidelines as Topic; Time-to-Treatment; Guideline Adherence; Schizophrenia; Female; Antipsychotic Agents; Adult; Polypharmacy; Clozapine; Male