Clozapine prescribing in adolescent psychiatry: survey of prescribing practice in in-patient units

Abstract

Aims and MethodClozapine is an effective drug in treatment-resistant schizophrenia, but it seems to be prescribed for few patients under the age of 18 years. This study reports a survey of consultant psychiatrists working in adolescent units in the UK, looking at their use of clozapine and experience with it.ResultsOut of 83 clinicians, 59 responded (71%). More than 40% of respondents do not use clozapine, and those who do may not always be following best practice recommendations. Reasons for not using clozapine, beliefs about its effectiveness and problems encountered in its use are described.Clinical ImplicationsClozapine may not always be made available to young people with treatment-resistant schizophrenia. There is a need for more education, guidance and debate on clozapine use in child and adolescent psychiatry.

The use of Clozapine in Adolescents: A Case Report

“…Furthermore, a delay in treatment is often associated with poor results, as the longer the duration of untreated psychosis the worse the condition becomes, with functional outcome declining sharply. 7,14 The persistent negative as well as positive symptoms are destructive to a child's development, to progress at school and to family and peer relationships, as was demonstrated in our case. The suicide rate in patients with childhood-onset schizophrenia has also been noted to be higher than in non-schizophrenics.…”

Long‐term sustained benefits of clozapine treatment in refractory early onset schizophrenia: A retrospective study in Korean children and adolescents

“…The burden of ''off label'' use and the small pool of information on the therapeutic dosage and adverse events may limit the use of clozapine despite its clinical benefits in VEOS (Cirulli, 2005;Findling et al, 2007;Kranzler et al, 2006). For Asian population, there is even fewer data on the pediatric use of clozapine (Dean et al, 2006).…”

“…Adult patients taking clozapine demonstrated better social adjustment (Meltzer, 1992) and fewer episodes of rehospitalization after switching to clozapine (Ahn et al, 2005;Chang et al, 2006;Meltzer et al, 1990;Pollack et al, 1998) not approved for use in the pediatric population. The ''off label'' use and the lack of sufficient information on the beneficial dosage and side effect profiles may have contributed to the under usage of clozapine despite its clinical benefits in youths suffering from schizophrenia (Cirulli, 2005;Findling et al, 2007;Kranzler et al, 2006). Double blind studies in VEOS patients are inherently difficult due to the severity and the rarity of the disorder (Gogtay and Rapoport, 2008;Kennedy et al, 2007).…”

Development of user-friendly consumer and health professional resources for the antipsychotic clozapine: a New Zealand example

“…However, shared-care arrangements with primary healthcare services, that is, general practitioners (GPs) and community pharmacies, are increasing for those people who are stable and well established on this medication. Despite its superior efficacy and beneficial health outcomes,1 many studies show underutilisation,2–5 delayed access4 6 7 and a reluctance by psychiatrists to prescribe clozapine 8 9. In response to both safety and access concerns, clinical guidelines that recommend appropriate monitoring and management of mental and physical health for people initiated on clozapine are available in many countries 10–12…”