Korean J Schizophr Res.  2021 Oct;24(2):52-59. 10.16946/kjsr.2021.24.2.52.

Effect of Delayed Clozapine Initiation on Acute Treatment Response in Treatment-Resistant Schizophrenia

Affiliations
  • 1Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 2Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 3Institute of Health Insurance & Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Abstract


Objectives
Recent studies have reported that delayed initiation of clozapine can affect clinical response in patients with treatment-resistant schizophrenia (TRS). This study aimed to explore the relationship between delayed initiation of clozapine and acute treatment response.
Methods
Sixty-five inpatients with TRS who started clozapine for the first time were included through a retrospective chart review. Acute treatment response was defined as a 30% reduction in the Positive and Negative Syndrome Scale score or a Clinical Global Impression of Improvement score of 1 (very much improved) or 2 (much improved) at 4 weeks after initiating clozapine.
Results
After meeting the TRS criteria, the mean delay for initiating clozapine was approximately 13.8 months. The delay was shorter in patients who showed a better response to clozapine in logistic regression analysis (p=0.037).
Conclusion
Our findings suggest that reducing the delay in initiating clozapine increases the effectiveness of clozapine in patients with TRS.

Keyword

Clozapine; Treatment delay; Treatment resistant schizophrenia; Treatment response; 조현병; 치료 반응; 치료저항성 치료지연; 클로자핀

Figure

  • Fig. 1. Methodology for the inclusion of study subjects. TD, Tardive dyskinesia.

  • Fig. 2. The example of schematic treatment course of multiple episode patients[33]. Definitions of delay in initiating clozapine in this study was demonstrated. ‘Onset of treatment-resistant schizophrenia (TRS)’ refers to a state which treatment resistance has developed intrinsically in the patients. This condition is difficult to recognize until failure of a 2nd antipsychotic drug is demonstrated in the hospital. ‘Diagnosis of TRS’ refers to non-response to 2nd antipsychotics trial at adequate dose and more than 4 weeks of duration. AP, antipsychotics; DUP, duration of untreated psychosis.


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