Doyle Roisin, Behan Caragh, OʼKeeffe Donal, Masterson Sarah, Kinsella Anthony, Kelly Aine, Sheridan Ann, Keating Dolores, Hynes Caroline, Madigan Kevin, Lawlor Elizabeth, Clarke Mary
From the *Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock; †Research Department, Saint John of God Hospitaller Ministries, Stillorgan, County Dublin; ‡School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin; §Pharmacy Department, Saint John of God Hospital, Stillorgan, County Dublin; ∥Saint John of God Community Mental Health Services, Stillorgan, County Dublin; #School of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin; and **School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland.
J Clin Psychopharmacol. 2017 Oct;37(5):512-517. doi: 10.1097/JCP.0000000000000734.
PURPOSE/BACKGROUND: For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms.
METHODS/PROCEDURES: Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171). Data were obtained from first presentation up to December 31, 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit.
FINDINGS/RESULTS: Twenty-eight (16.3%) of the cohort were prescribed clozapine. Data were available for 24 individuals. Of this clozapine subsample, the mean age at baseline was 23.11 (SD = 4.58); 82.14% (n = 23) were male; and 82.14% (n = 23) had a baseline diagnosis of schizophrenia. The mean time to first trial of clozapine was 6.7 years. The mean number of antipsychotics prescribed before clozapine trial was 4.85. After the initiation of clozapine, the mean number of hospital admissions reduced from 6.04 per year to 0.88 per year.
IMPLICATIONS/CONCLUSIONS: Nearly 1 in 5 of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. The use of clozapine for treatment-resistant schizophrenia is underutilized, and better understanding of the barriers to prescribing clozapine is necessary given the implications for patient's quality of life and hospital admission rates. Physical health data further emphasizes the importance of physical health monitoring in this vulnerable population.
目的/背景：在接受精神病或精神分裂症治疗的个体中，约三分之一的人使用抗精神病药物几乎没有或根本没有治疗效果。氯氮平仍然是唯一被批准用于治疗难治性精神分裂症的药物，并且研究已经证明其在减轻精神病症状方面具有卓越疗效。
方法/程序：数据收集自1995年至1999年首次出现首发精神病的患者的病历（N = 171）。数据获取时间从首次就诊至2013年12月31日，或直至患者出院或转院。使用专门为此审计设计的数据收集模板收集有关服务使用和身体健康的信息。
该队列中有28人（16.3%）被开具氯氮平处方。有24人的数据可用。在这个氯氮平子样本中，基线时的平均年龄为23.11岁（标准差 = 4.58）；82.14%（n = 23）为男性；82.14%（n = 23）基线诊断为精神分裂症。首次试用氯氮平的平均时间为6.7年。在试用氯氮平之前开具的抗精神病药物的平均数量为4.85种。开始使用氯氮平后，每年的平均住院次数从每年6.04次降至每年0.88次。
启示/结论：在最初的队列中，近五分之一的人被认为对抗精神病药物试验的反应不理想。氯氮平在难治性精神分裂症治疗中的使用未得到充分利用，鉴于其对患者生活质量和住院率的影响，有必要更好地了解开具氯氮平的障碍。身体健康数据进一步强调了对这一弱势群体进行身体健康监测的重要性。
