Educational needs and psychoeducation interventions in clozapine users: a narrative review

Abstract

Verdoux H, Quiles C. Educational needs and psychoeducation interventions in clozapine users: a narrative review. Objective: Increasing users' knowledge about the expected benefits and risks of clozapine may contribute to the initiation and maintenance of clozapine in persons with treatment-resistant schizophrenia (TRS). The objective was to identify the educational needs of clozapine users and the interventions aimed at addressing these needs. Method: We systematically searched multiple electronic databases for articles: (i) exploring educational needs of clozapine users and of their relatives; and (ii) reporting educational interventions aimed at addressing these needs. Data were synthesized narratively. Results: A total of 30 articles published from 1990 to 2019 in 8 countries fulfilled our inclusion criteria. As most studies on educational needs (n = 18) were carried out in persons already taking clozapine, educational needs of TRS patients who were candidates for clozapine treatment are not well documented. Users' level of knowledge about clozapine was often poor, especially about adverse effects or interactions with other substances, with a poor retention of information delivered at treatment initiation. Among 12 studies reporting educational interventions in clozapine users, five provided quantitative outcomes. Their findings suggest that structured educational programmes may contribute to promote clozapine initiation and to improve users' knowledge about this drug. Conclusion: The literature is sparse on structured educational interventions about clozapine, and only one randomized controlled trial was identified. A promising strategy emerging from this review may be staging educational interventions according to the evolving needs of persons with TRS before clozapine use, at initiation and during maintenance treatment.

Clozapine prescription rates in Southeast Europe: A cross-sectional study

“…Examples of initiatives developed in the Netherlands (i.e., Dutch Clozapine Collaboration Group) and New Zealand aimed at increasing evidence-based knowledge on clozapine prescription (through regular audits and the inclusion of formal training on clozapine prescription for psychiatry residency) that resulted in increased clozapine’ prescription should be taken into account to implement clozapine prescription and adherence to guidelines ( 18 ). Similarly, patients have the right to make an informed decision about their treatment with clozapine, therefore, being educated about that would be an essential part of the process to guarantee engagement throughout the therapy ( 56 ).…”

Consenso argentino sobre diagnóstico y tratamiento de la esquizofrenia resistente al tratamiento

“…Las evaluaciones recomendadas en las guías, consensos y otros documentos, cuyo objetivo es determinar si la persona que padece esquizofrenia se considera resistente al tratamiento con antipsicóticos (ERT) se vinculan a la persona, a los fármacos y al contexto (Buckley & Gaughran, 2014;Nucifora et al, 2019;Farooq et al, 2013;Howes et al, 2017;Kane et al, 2019;Lally & Gaughran, 2019;Pharoah et al, 2010;Van Sant & Buckley, 2011;Verdoux & Quiles, 2020)…”

Escaping the Long Shadow Cast by Agranulocytosis

“…monitoring and, in some countries, burdensome regulations mean that clozapine is prescribed unevenly across the world. 3 The US package insert has a very long list of clozapine ADRs but provides 5 box warnings for (1) severe neutropenia; (2) orthostatic hypotension, bradycardia, and syncope; (3) seizure; (4) myocarditis, cardiomyopathy, and mitral valve incompetence; and (5) increased mortality in elderly patients with dementia-related psychosis.…”

“…There is general agreement in the literature that clozapine is highly effective in treatment-resistant schizophrenia (TRS). On the other hand, there is a need for education 1,2 because some prescribers who do not prescribe clozapine are unjustifiably concerned about adverse drug reactions (ADRs) in clozapine-treated patients. In addition, the complications of dealing with hematological monitoring and, in some countries, burdensome regulations mean that clozapine is prescribed unevenly across the world 3 .…”