Abstract

Comparison of pre-treatment clinical characteristics and post-treatment outcomes of patients treated with Clozapine and long acting antipsychotics

Author(s): Dante M Durand, Phillip Harvey, Ricardo Caceda

Introduction:

Clozapine is a cornerstone in the treatment of resistance schizophrenia, whereas long-acting antipsychotics (LAA) are central in the care of patients with poor compliance. Both populations represent daunting challenges. We aim to compare pre-treatment disease severity and treatment outcome of patients receiving clozapine and LAA.

Methods:

Medical records of patients who attend an outpatient schizophrenia clinic were randomized and examined retrospectively. Demographics and psychiatric history prior hospitalizations and suicide attempts were reviewed. Additionally, the Positive and Negative Symptom Scale (PANSS) and Medication Adherence Rating Scale (MARS) were administered to patients during their last visit.

Results:

Preliminary results from 27 patients show that those on LAA had more hospitalizations (p=0.021) and suicide attempts (75% vs. 11%, p=0.034) than patients on clozapine before initiation of treatment. There were no differences in frequency of visits, MARS or PANSS scores between the two groups. Negative symptoms were more predominant among the patients on long-acting antipsychotics than in those on clozapine, although the difference was borderline significant.

Discussion:

Patients on LAA had a more severe disease course prior to the initiation of LAA, reflected in more hospitalizations and suicide attempts, possibly due to persistent non-compliance with oral treatment in the past. Patients on clozapine had more recent hospitalizations, perhaps due to suboptimal dosing. Treatment adherence and symptom burden were similar in both patient groups. There was an expected trend of patients on long acting antipsychotics to display poorer negative symptom control than those on clozapine.