Subscribe to RSS
DOI: 10.1055/s-0035-1555939
Clozapine Prescription and Quality of Life in Chinese Patients with Schizophrenia Treated in Primary Care
Publication History
received 16 April 2015
revised 04 June 2015
accepted 02 July 2015
Publication Date:
05 August 2015 (online)
![](https://www.thieme-connect.de/media/pharmaco/201506/lookinside/thumbnails/2015-04-0448_10-1055-s-0035-1555939-1.jpg)
Abstract
Objective: Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China.
Method: A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients’ socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection.
Results: The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics.
Conclusions: Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.
* These authors contributed equally to the paper.
-
References
- 1 Suzuki T, Uchida H, Watanabe K et al. Factors associated with response to clozapine in schizophrenia: a review. Psychopharmacol Bull 2011; 44: 32-60
- 2 Meltzer HY, Alphs L, Green AI et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60: 82-91
- 3 Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. A J Psychiatry 1995; 152: 183-190
- 4 Modestin J, Dal Pian D, Agarwalla P. Clozapine diminishes suicidal behavior: a retrospective evaluation of clinical records. J Clin Psychiatry 2005; 66: 534-538
- 5 Walker AM, Lanza LL, Arellano F et al. Mortality in current and former users of clozapine. Epidemiology 1997; 8: 671-677
- 6 Miller A, Hall CS, Buchanan RW et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry 2004; 65: 500-508
- 7 Tiihonen J, Lonnqvist J, Wahlbeck K et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009; 374: 620-627
- 8 Harrison J, Janlov M, Wheeler AJ. Patterns of clozapine prescribing in a mental health service in New Zealand. Pharm World Sci 2010; 32: 503-511
- 9 Henderson DC, Nguyen DD, Copeland PM et al. Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality: results of a 10-year naturalistic study. J Clin Psychiatry 2005; 66: 1116-1121
- 10 Barnes TR. Schizophrenia Consensus Group of British Association for P. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25: 567-620
- 11 NICE . Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia: technology appraisal. London: 2002
- 12 Alessi-Severini S, Le Dorze JA, Nguyen D et al. Clozapine prescribing in a Canadian outpatient population. PloS one 2013; 8: e83539
- 13 Howes OD, Vergunst F, Gee S et al. Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry 2012; 201: 481-485
- 14 Latimer E, Wynant W, Clark R et al. Underprescribing of clozapine and unexplained variation in use across hospitals and regions in the Canadian province of Quebec. Clinical schizophrenia & related psychoses 2013; 7: 33-41
- 15 Warnez S, Alessi-Severini S. Clozapine: a review of clinical practice guidelines and prescribing trends. BMC psychiatry 2014; 14: 102
- 16 Haro JM, Salvador-Carulla L. The SOHO (Schizophrenia Outpatient Health Outcome) study: implications for the treatment of schizophrenia. CNS drugs 2006; 20: 293-301
- 17 Xiang YT, Wang CY, Si TM et al. Antipsychotic polypharmacy in inpatients with schizophrenia in Asia (2001–2009). Pharmacopsychiatry 2012; 45: 7-12
- 18 Liu TL, Li CY. The comparison of use of antipsychotics in first-episode patients with schizophrenia (in Chinese). Medical journal of Chinese people Health 2003; 15: 289-290
- 19 Xiang YT, Weng YZ, Leung CM et al. Clinical correlates of clozapine prescription for schizophrenia in China. Human psychopharmacology 2007; 22: 17-25
- 20 Si TMSL, Yu X, Ma X et al. Antipsychotic drug patterns of schizophrenia in China: a cross sectional study (in Chinese). Chinese J Psychiatry 2004; 37: 152-155
- 21 Liang H, Xue Y, Byrd TA et al. Electronic data interchange usage in China's healthcare organizations: the case of Beijing's hospitals. 2004; 24: 507-522
- 22 Voruganti L, Heslegrave R, Awad AG et al. Quality of life measurement in schizophrenia: reconciling the quest for subjectivity with the question of reliability. Psychol Med 1998; 28: 165-172
- 23 APA . Practice Guideline for the Treatment of Patients with Schizophrenia. Washington, DC: American Psychiatric Press; 1997
- 24 Kane JM, Aguglia E, Altamura AC et al. Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy. Eur Neuropsychopharmacol 1998; 8: 55-66
- 25 Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64: 663-667
- 26 Overall JE, Beller SA. The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit. J Gerontol 1984; 39: 187-193
- 27 Zhang MY, Zhou TJ, Tang SH et al. The application of the Chinese version of the Brief Psychiatric Rating Scale (BPRS) (in Chinese). Chinese Journal of Nervous and Mental Diseases 1983; 9: 76-80
- 28 Simpson GM, Angus JW. A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 1970; 212: 11-19
- 29 Kreinin A, Novitski D, Weizman A. Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study. Int Clin Psychopharmacol 2006; 21: 99-103
- 30 Lam CL, Tse EY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual. Life Res 2005; 14: 539-547
- 31 McEvoy JP, Aland Jr J, Wilson WH et al. Measuring chronic schizophrenic patients attitudes toward their illness and treatment. Hosp Community Psychiatry 1981; 32: 856-858
- 32 Ng CH, Ma H, Yu X et al. China-Australia-Hong Kong tripartite community mental health training program. Asia-Pacific Psychiatry 2009; 1: 90-97
- 33 Xiang YT, Yu X, Sartorius N et al. Mental health in China: challenges and progress. Lancet 2012; 380: 1715-1716
- 34 Liu Q, Wang B, Kong Y et al. China’s primary health-care reform. Lancet 2011; 377: 2064-2066
- 35 Xiang YT, Wang CY, Si TM et al. Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009. Aust N Z J Psychiatry 2011; 45: 968-975
- 36 Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration – New York metropolitan region. Schizophr Bull 2002; 28: 31-42
- 37 Nielsen J, Roge R, Schjerning O et al. Geographical and temporal variations in clozapine prescription for schizophrenia. Eur Neuropsychopharmacol 2012; 22: 818-824
- 38 Chinese Medical Association . Guideline for the Prevention and Treatment of Psychiatric Disorders in China. Beijing: Chinese Medical Association; 2003
- 39 Esposito D, Rouillon F, Limosin F. Continuing clozapine treatment despite neutropenia. Eur J Clin Pharmacol 2005; 60: 759-764
- 40 Schulte P. What is an adequate trial with clozapine?: therapeutic drug monitoring and time to response in treatment-refractory schizophrenia. Clin Pharmacokinet 2003; 42: 607-618
- 41 Malalagama G, Bastiampillai T, Dhillon R. Clozapine prescription patterns in Australia over the last 10 years. Aust N Z J Psychiatry 2011; 45: 498-499
- 42 Kane J, Honigfeld G, Singer J et al. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789-796
- 43 Young CR, Bowers Jr MB, Mazure CM. Management of the adverse effects of clozapine. Schizophr Bull 1998; 24: 381-390
- 44 Williams R. Optimal dosing with risperidone: updated recommendations. J Clin Psychiatry 2001; 62: 282-289
- 45 Lane HY, Chang WH. Clozapine versus risperidone in treatment-refractory schizophrenia: possible impact of dosing strategies. J Clin Psychiatry 1999; 60: 487-488
- 46 Meltzer HY. Clozapine: balancing safety with superior antipsychotic efficacy. Clinical schizophrenia & related psychoses 2012; 6: 134-144
- 47 Yang HC, Yang KJ, Liu TB et al. The clinical chacateristics of patients with treatment-resistant schizophrenia (in Chinese). Medical Journal of Chinese People’s Health 2005; 17: 257-259
- 48 Remington G, Saha A, Chong SA et al. Augmentation strategies in clozapine-resistant schizophrenia. CNS drugs 2005; 19: 843-872
- 49 Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines. London: Martin Dunitz; 2003