BARRIERS TO CLOZAPINE USE IN TREATMENT-REFRACTORY POPULATION IN KARACHI, PAKISTAN
Abstract
Objective: To investigate the causes accountable for serving as barriers in prescribing clozapine in several outpatient departments in Karachi, Pakistan.
Study Desgin: A cross- Sectional Study.
Duration and Place od Study: Psychiatrist and residents conducting clinics in karachi, May to July 2022.
Method: This study was conducted over three months periods, using a structured questionnaire from 105 physicians with previous formal training in psychiatry. Statistical analysis was done using the Chi-Square test of association.
Results: Out of 105 doctors offering psychiatric services at various locations, 70% mentioned that they were uncomfortable prescribing clozapine earlier in the course, with its adverse effects profile being the most popular reason for its avoidance by the patients and/or their families. Clozapine's availability and its cost were also common barriers to prescribing clozapine. Most doctors agreed that they would have felt more comfortable if they had had some clozapine training and attended clozapine clinics during their training.
Conclusion: The anticipation of medication nonadherence and monitoring requirements coupled with overestimating the adverse effect profile stems from inadequate experience with the drug Steps should be taken by the graduate medical education at the training hospitals to organize clozapine clinics and offer clozapine training to promote the use of this effective drug to improve the prognosis and function suffering from this debilitating illness.
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References
Charlson FJ, Ferrari AJ, Santomauro DF, et al. Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016. Schizophr Bull. 2018;44(6):1195-1203. doi:10.1093/schbul/sby058
Health care reform for Americans with severe mental illnesses: report of the National Advisory Mental Health Council. Am J Psychiatry. 1993;150(10):1447-1465. doi:10.1176/ajp.150.10.1447
Bishara D, Taylor D. Adverse effects of clozapine in older patients: epidemiology, prevention and management. Drugs Aging. 2014;31(1):11-20. doi:10.1007/s40266-013-0144-2
Shah P, Iwata Y, Plitman E, et al. The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia: A systematic review. Psychiatry Res. 2018;268:114-122. doi:10.1016/j.psychres.2018.06.070
Blackman G, Lisshammar JEL, Zafar R, et al. Clozapine Response in Schizophrenia and Hematological Changes. J Clin Psychopharmacol. 2021;41(1):19-24. doi:10.1097/JCP.0000000000001329
Rubio JM, Kane JM. How and when to use clozapine. Acta Psychiatr Scand. 2020;141(3):178-189. doi:10.1111/acps.13111
Every-Palmer S, Ellis PM. Clozapine-Induced Gastrointestinal Hypomotility: A 22-Year Bi-National Pharmacovigilance Study of Serious or Fatal 'Slow Gut' Reactions, and Comparison with International Drug Safety Advice. CNS Drugs. 2017;31(8):699-709. doi:10.1007/s40263-017-0448-6
Wahlbeck K, Cheine M, Essali A, Adams C. Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta-analysis of randomized trials. Am J Psychiatry. 1999;156(7):990-999. doi:10.1176/ajp.156.7.990
Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199-210. doi:10.1001/jamapsychiatry.2015.2955
Jones PB, Barnes TR, Davies L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry. 2006;63(10):1079-1087. doi:10.1001/archpsyc.63.10.1079
Nielsen J, Røge R, Schjerning O, Sørensen HJ, Taylor D. Geographical and temporal variations in clozapine prescription for schizophrenia. Eur Neuropsychopharmacol. 2012;22(11):818-824. doi:10.1016/j.euroneuro.2012.03.003
Trinczek E, Heinzel-Gutenbrunner M, Haberhausen M, Bachmann CJ. Time to Initiation of Clozapine Treatment in Children and Adolescents with Early-Onset Schizophrenia. Pharmacopsychiatry. 2016;49(6):254-259. doi:10.1055/s-0042-116947
Wheeler AJ. Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand. Ann Pharmacother. 2008;42(6):852-860. doi:10.1345/aph.1K662
Üçok A, Çikrikçili U, Karabulut S, et al. Delayed initiation of clozapine may be related to poor response in treatment-resistant schizophrenia. Int Clin Psychopharmacol. 2015;30(5):290-295. doi:10.1097/YIC.0000000000000086
Schulte PFJ, Bogers J, Bond-Veerman SRT, Cohen D. Moving forward with clozapine. Acta Psychiatr Scand. 2020;142(2):75-77. doi:10.1111/acps.13224
Shad MU, Felzien E, Roy K, Sethi S. How to identify and manage non-response to clozapine?. Asian J Psychiatr. 2019;45:50-52. doi:10.1016/j.ajp.2019.08.016
Moody BL, Eatmon CV. Perceived Barriers and Facilitators of Clozapine Use: A National Survey of Veterans Affairs Prescribers. Fed Pract. 2019;36(Suppl 6):S22-S27.
Farooq S, Choudry A, Cohen D, Naeem F, Ayub M. Barriers to using clozapine in treatment-resistant schizophrenia: systematic review. BJPsych Bull. 2019;43(1):8-16. doi:10.1192/bjb.2018.67
Ismail D, Tounsi K, Zolezzi M, Eltorki Y. A qualitative exploration of clozapine prescribing and monitoring practices in the Arabian Gulf countries. Asian J Psychiatr. 2019;39:93-97. doi:10.1016/j.ajp.2018.12.011
Schizophrenia and related psychoses. In: The Maudsley Prescribing Guidelines in Psychiatry. 13th ed.Wiley Blackwell; 2018. p. 156–7. Available from: https://dl.uswr.ac.ir/bitstream/Hannan/32636/1/9781119442608.pdf
Atkin K, Kendall F, Gould D, Freeman H, Liberman J, O'Sullivan D. Neutropenia and agranulocytosis in patients receiving clozapine in the UK and Ireland. Br J Psychiatry. 1996;169(4):483-488. doi:10.1192/bjp.169.4.483
Singh B, Hughes AJ, Roerig JL. Comfort Level and Barriers to the Appropriate Use of Clozapine: a Preliminary Survey of US Psychiatric Residents. Acad Psychiatry. 2020;44(1):53-58. doi:10.1007/s40596-019-01134-7
Verdoux H, Quiles C, Bachmann CJ, Siskind D. Prescriber and institutional barriers and facilitators of clozapine use: A systematic review. Schizophr Res. 2018;201:10-19. doi:10.1016/j.schres.2018.05.046
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