School of Medicine,The University of Queensland,Brisbane, Qld,Australia.
Policy and Epidemiology Group,Queensland Centre for Mental Health,Brisbane, Qld,Australia.
Epidemiol Psychiatr Sci. 2017 Jun;26(3):325-337. doi: 10.1017/S2045796016000305. Epub 2016 Jul 18.
Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.
Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n = 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.
One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.
Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.
氯氮平是治疗难治性精神分裂症最有效的药物。然而，在常规临床环境中，关于使用氯氮平的精神健康和合并症情况以及护理经验的描述却很少。我们利用 2010 年澳大利亚高影响力精神病学调查的数据，旨在检查使用氯氮平的人群比例，并比较氯氮平使用者与其他抗精神病药物使用者在人口统计学、精神健康、药物不良反应、联合用药和治疗满意度方面的差异。
从一项针对过去 12 个月内接触过精神卫生服务的有精神病性障碍的人群的代表性澳大利亚调查中，提取了 1049 名被诊断为精神分裂症或分裂情感障碍的患者的数据，这些患者报告在过去 4 周内服用过任何抗精神病药物。我们比较了服用氯氮平（n=257，22.4%）和其他抗精神病药物的参与者在一系列人口统计学、临床和治疗相关指标方面的差异。
四分之一的参与者正在服用氯氮平。在患有慢性疾病的参与者中，只有三分之一的人在服用氯氮平。在调整诊断和疾病慢性程度后，尽管终生使用氯氮平的几率相似，但服用氯氮平的参与者当前饮酒、吸食大麻和其他药物的几率显著降低。代谢综合征和糖尿病在服用氯氮平的人群中更为常见；慢性疼痛则较少见。两组人群的精神药物联合用药并无差异。
与氯氮平使用不足的国际证据一致，许多患有慢性疾病和高症状负担的参与者并未服用氯氮平。氯氮平使用者当前药物使用和慢性疼痛的概率较低，值得进一步研究。
