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Influence of time to clozapine prescription on the clinical outcome.

Accepted version
Peer-reviewed

Type

Article

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Authors

Muñoz-Manchado, Leticia I 
Perez-Revuelta, Jose I 
Banerjee, Arka 
Galindo-Guarin, Liliana 
Bernardo, Miguel 

Abstract

BACKGROUND: This study investigates whether early clozapine use is associated with improved responses in different clinical domains, including positive and negative symptoms, functioning, and well-being. METHODS: Data from 254 clozapine-treated patients at Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) were analysed. Among them, 231 (90.9 %) had a diagnosis of schizophrenia, 21 (8.3 %) schizoaffective disorder, and 2 (0.8 %) had other diagnoses. The International Classification of Diseases-Mortality and Morbidity Statistics criteria (ICD-10) were employed (World Health Organization, 1992). The cohort was assessed using the positive and negative syndrome scale (PANSS), the Brief Negative Symptom Scale (BNSS), Global Assessment of Functioning Scale (GAF), and the short version of Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Logistic regression models (for positive and negative symptom remission) and linear regression (for functioning and well-being) were utilized to assess the influence of time to clozapine initiation (TCI), age at the first episode of psychosis (AFE), duration of clozapine treatment (DCT), and gender. RESULTS: Early clozapine treatment (within the first three years after the first episode of psychosis) was associated with increased negative symptom remission (exp (B) = 0.38; p = 0.02) and higher functioning scores (β = -0.12, p = 0.046). However, no effect of time to clozapine initiation was found on positive symptom remission rates or well-being scores. CONCLUSIONS: Initiating clozapine treatment within the first 3 years of the first episode of psychosis may lead to reduced severity of negative symptoms and improved functioning in clozapine-treated patients. The time to clozapine initiation did not influence its effect on positive symptom remission rates.

Description

Keywords

Delay, Duration of psychosis, Negative symptoms, Remission, Treatment-resistant schizophrenia, Humans, Clozapine, Male, Female, Adult, Antipsychotic Agents, Schizophrenia, Psychotic Disorders, Middle Aged, Young Adult, Psychiatric Status Rating Scales, Treatment Outcome, Time-to-Treatment, Time Factors

Journal Title

Schizophr Res

Conference Name

Journal ISSN

0920-9964
1573-2509

Volume Title

Publisher

Elsevier BV
Sponsorship
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (MR/W029987/1)