C.LAW1, J.LEE1, Y.M.SEE1, J.Y.YEE1, C.TANG1, B.T.NG1
Institute of Mental Health1
Clozapine has specific indication for use in treatment resistant schizophrenia (TRS) as a 3rd line antipsychotic. In this study, we seek to examine the profile and outcomes of patients currently on Clozapine.
We conducted a cross-sectional study at the Institute of Mental Health on patients aged 21 to 80 years, on a stable dose of Clozapine for 2 weeks. Each participant underwent a clinical assessment with the Positive and Negative Syndrome Scale (PANSS) and Social Occupational Functioning Assessment Scale (SOFAS). Symptomatic remission status was defined using the PANSS symptom criteria proposed by Andreasen et al (2005). Functional remission was defined as SOFAS scores ≥60.
162 participants were recruited. The mean age was 39.9 years; 104 (64.2%) were males; 156 (96.3%) were diagnosed with Schizophrenia, 3 (1.9%) Schizoaffective and 3 (1.9%) Bipolar disorder. 25 participants (15.7%) achieved symptomatic remission and 101 (63.5%) achieved functional remission. The median number of antipsychotic trials before Clozapine initiation was 6 (range 2-14). While the median number of trials between the symptomatic remitters and non-remitters were not statistically significant (5.5 vs 6, p=0.1), it was statistically significant in the functional remitters as compared to non-remitters (6 vs 7, p=0.027).
Our study found a significant delay in the initiation of Clozapine. This delay might have contributed to the poorer remission outcomes; a finding similarly reported in other studies. Further research is needed to provide a clearer understanding of Clozapine delay, evaluate its impact on outcomes, and find ways to improve access to Clozapine.