Antipsychotic prescribing before clozapine in a community psychiatric hospital: a case note review.

Objective: To examine whether prescribing Clozapine was delayed in Treatment Resistant Schizophrenia (TRS), and elucidate possible reasons for this.

Methods: A retrospective Case note review was done. The main outcome measured was the mean maximum theoretical delay in starting Clozapine. In analyses, mean values were compared using an unpaired, 2-sided Student t-test. The association between duration of illness and theoretical delay was analysed by scatterplot and Pearson correlation coefficient.

Results: 42 case notes were reviewed. Mean age of subjects was 40.1 years. The mean maximum theoretical delay in all patients was 5 years. A statistically significant longer delay was found in patients over 30 years, patients diagnosed with TRS before 1991,and for patients before the introduction of Risperidone. Delay was significantly shorter for patients admitted to a psychiatric hospital more than once a year.

Conclusions: There is a strong indication that Clozapine was not introduced at the earliest opportunity. Factors contributing to the delay include the patient's age, using sequential antipsychotic trials, and the failure to identify TRS. The use of Clozapine appears to have been adopted more in recent years, with a delay of five years to Clozapine for those diagnosed pre-1991, reducing to two years for those diagnosed pre-2003. Conclusions: Mean average delay of prescribing clozapine was 5 years. Statistically significant delays in patients over 30 years of age. Conclusions: There was no evaluation of: Reasons for co-prescribing of antipsychotics. Reasons for delay in prescribing Clozapine, e.g. prescriber inexperience, patient choice, risk of non-compliance etc. Evidence of treatment resistance, and whether primary or secondary in onset.