Clozapine Use in Patients with Early-Stage Schizophrenia in a Chinese Psychiatric Hospital

Experience with and attitude toward clozapine use among patients receiving clozapine on long term and their caregivers

Background

Despite clozapine being the gold standard for treating patients suffering from treatment-resistant schizophrenia, the experience and attitude of patients receiving clozapine for a long duration and their caregivers have not been evaluated, especially in India and other low-middle-income countries. Also, no standardized scale has been validated for such assessment.

Objective

This study aimed to evaluate the perception regarding clozapine among patients and their caregivers. We also attempted to evaluate the factor structure of the scale for such assessment.

Methods

A total of 172 consenting patients who have been receiving clozapine for ≥1 year and their caregivers were evaluated on self-designed questionnaires (patient and caregiver versions containing 44 and 47 items, respectively) to assess various aspects of their experiences about clozapine use.

Results

A majority (70-80%) of patients and caregivers reported improvement in psychotic symptoms, mood symptoms, and overall functioning with starting of clozapine. However, about 40% of the patients reported cognitive side effects, and 20-25% reported disabling side effects like lethargy, forgetfulness and decreased attention, and distress related to blood testing after starting of clozapine. Factor analysis of the questionnaires yielded five- and seven-factor models for the experience and attitude of the patients and the caregivers, respectively. The positive experiences were associated clinical and functional improvement, lower disability, and improvement in functioning as well as the self-reported perceived improvement by the patient and caregiver.

Conclusion

This study suggests that patients tend to have an overall positive experience and attitude about using clozapine. The caregivers also report the beneficial effect on the caregiving. A good level of agreement was seen between the experience of patients, caregivers, and clinician-rated improvement in the psychopathology and functioning.

Two-year cohort-up study of clozapine prescription in Chinese patients with schizophrenia treated in rural primary care

Few studies have examined the clozapine in cohort studies of Chinese patients with schizophrenia in rural primary care. The objective of this two-year cohort study was to describe the usage of clozapine and investigate and identify the demographic, clinical correlations and risk variables which affect the use of clozapine in patients with schizophrenia. A random cluster sampling technique was used, and participants were collected from China National Psychiatric Management System (CNPMS). The variables for clozapine use in individuals with schizophrenia who had undergone a two-year follow-up were determined using the generalized estimating equation (GEE). In this study, 742 patients with schizophrenia were invited, and 491 completed the two-year follow-up study. Being married, more years of education, more waist circumference, using mood stabilizer, using anticholinergic, higher ITAQ (Insight and Treatment Attitude Questionnaire) scores were more significantly related to the use of clozapine. Older age of onset, using second-generation antipsychotics (SGAs) except clozapine predicted a lower prevalence of using clozapine. The usage of clozapine was very common in patients with schizophrenia treated by primary care physicians, and was influenced by a variety of factors, including price of drugs, clinical factors, health regulations, and the characteristics of treatment environment. Further examination of the rationale and appropriateness of clozapine in primary care in China is necessary.