Iranian psychiatrists’ attitude towards clozapine use for patients with treatment-resistant schizophrenia: a nationwide survey

Abstract

Background Clozapine has the greatest efficacy for treatment-resistant schizophrenia (TRS), even though its underutilization is not uncommon across different countries. This study aimed to investigate the knowledge and attitude of Iranian psychiatrists toward clozapine use. Method In this cross-sectional study, a questionnaire was distributed among psychiatrists registered with the Iranian Psychiatrists Association (including its provincial branches) to assess their knowledge and attitude towards clozapine use. A total of 282 psychiatrists completed the questionnaire. Descriptive analysis was used to describe demographic information, and Chi-square tests were conducted to determine if there is an association between academic position and work experience. All statistical analyses were performed using SPSS® version 25.0 for Windows, and a significance level of 0.05 was used. Results Most respondents (93%) acknowledged that they prescribed clozapine for their patients, and 74% believed that clozapine was more effective than other antipsychotic drugs. However, 43.3% of the respondents said they did not believe in the safety of clozapine. Difficulty initiating and having no firsthand experience in the superiority of clozapine were reported by 81.2 and 80% of the respondents, respectively. Our results also showed an association between having an academic position and access to appropriate facilities for the control and management of patients treated with clozapine and believing in the safety of clozapine (p < 0.05). Longer work experience (more than 15 years) was associated with a higher prescription of clozapine, belief in greater effectiveness of clozapine, and its safety (p < 0.0001). Conclusion Iranian psychiatrists had a good self-perception of knowledge about the efficacy of clozapine for patients with TRS, but concerns about serious side effects are common. Psychiatrists with longer work experience and academic positions were more optimistic towards clozapine use than the younger ones with no academic position. Considering the results in planning the strategies to decrease concerns about clozapine use is recommended.

Managing treatment resistance in schizophrenia: A joint study in Hong Kong and Singapore

“…Health system factors were also identified as a barrier and clinicians in Hong Kong and Singapore reported a greater need for outpatient resources in terms of clinic and administrative support to improve clozapine prescription (25). These findings were echoed by similar surveys of clinicians in other countries (18)(19)(20)(21)(22)(23).…”

“…A 2015 study in the UK by Tungaraza and Farooq ( 24 ) found that 40.5% of psychiatrists preferred to use several other antipsychotics before considering clozapine. 73% of psychiatrists in an Iranian study likewise preferred other strategies to clozapine when treatment fails with two or three antipsychotics ( 20 ). 61.3% of psychiatrists in India would use clozapine in patients who have failed 2 antipsychotics, 17.3% would prefer polypharmacy, 10% would use polypharmacy with clozapine as one of the agents ( 19 ).…”

“…Understanding clinicians’ practice is the first step in elucidating the gaps that exist in the treatment of patients with TRS. Surveys of clinician attitude toward clozapine prescription have been conducted in various countries, including Denmark ( 18 ), India ( 19 ), Iran ( 20 ), Israel ( 21 ), Serbia ( 22 ), and the United Kingdom (UK; 23 , 24 ). Most of these studies focused on describing the clinicians’ knowledge and attitudes toward clozapine and their perception of the barriers toward clozapine prescription.…”

What is the extent of research assessing patients’ and clinicians’ perspectives on clozapine treatment? – a comprehensive scoping review

“…No other published studies within the identified underprioritized areas were found. Instead, eight additional studies on general clinician perspectives on clozapine treatment [203][204][205][206][207][208][209][210] , three additional studies on clozapinepatients' (and their clinicians') attitudes towards their ongoing treatment 40 211 212 , and three additional studies on case-note derived reasons for clozapine cessation or withholding [213][214][215] appeared, ratifying the repetitive behavior of current research and the importance of disseminating these results in order to direct future research towards more meaningful and less well-described areas.…”