Grover Sandeep, Naskar Chandrima, Chakrabarti Subho
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Psychiatry. 2023 Nov;65(11):1165-1175. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_585_23. Epub 2023 Nov 24.
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.
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.
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.
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.
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.
尽管氯氮平是治疗难治性精神分裂症患者的金标准，但长期接受氯氮平治疗的患者及其照料者的体验和态度尚未得到评估，尤其是在印度和其他中低收入国家。此外，尚无经过验证的标准化量表用于此类评估。
本研究旨在评估患者及其照料者对氯氮平的认知。我们还试图评估此类评估量表的因子结构。
对172名接受氯氮平治疗≥1年的同意参与研究的患者及其照料者进行了自设问卷评估（患者版和照料者版问卷分别包含44项和47项），以评估他们使用氯氮平的各方面体验。
大多数（70 - 80%）患者和照料者报告，开始使用氯氮平后，精神病性症状、情绪症状及整体功能均有改善。然而，约40%的患者报告有认知副作用，20 - 25%的患者报告有诸如嗜睡、健忘、注意力下降等致残性副作用，以及开始使用氯氮平后与血液检测相关的困扰。问卷的因子分析分别得出了患者体验和态度的五因子模型以及照料者体验和态度的七因子模型。积极体验与临床和功能改善、较低的残疾程度、功能提升以及患者和照料者自我报告的感知改善相关。
本研究表明，患者对使用氯氮平总体上倾向于有积极的体验和态度。照料者也报告了氯氮平对照料的有益影响。在患者、照料者的体验与临床医生评定的精神病理学及功能改善之间，观察到了较高程度的一致性。
