ArticleBJPsych open2020
Prevalence of treatment resistance and clozapine use in early intervention services.
Article in BJPsych open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Cariprazine and clozapine: a systematic review of a promising antipsychotic combination for treatment-resistant schizophrenia.The international journal of neuropsychopharmacology · 2025Pooled it
- Ethnic disparities in clozapine prescription for service-users with schizophrenia-spectrum disorders: a systematic review.Psychological medicine · 2022Pooled it
- A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia.CNS drugs · 2022Guideline
- Neuropsychological differences between treatment-resistant and treatment-responsive schizophrenia: a meta-analysis.Psychological medicine · 2022Pooled it
- From early intervention in psychosis to intensive care: correlates of restrictive psychiatric practice in a national retrospective cohort study.The British journal of psychiatry : the journal of mental science · 2026Article
- Treatment resistance in first-episode psychosis.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2026Article
- Adult psychiatrists' views on clozapine prescribing for schizophrenia in Germany-an online survey.Therapeutic advances in psychopharmacology · 2026Article
- Prevalence of treatment-resistant schizophrenia among people with early psychosis and its clinical and demographic correlates.The Australian and New Zealand journal of psychiatry · 2024Article
- Multimodal prediction of the need of clozapine in treatment resistant schizophrenia; a pilot study in first-episode psychosis.Biomarkers in neuropsychiatry · 2024Article
- Long-term clinical recovery and treatment resistance in first-episode psychosis: a 10-year follow-up study.Schizophrenia (Heidelberg, Germany) · 2024Article
- Clozapine Use Among People With Psychotic Disorders Who Experience Specific Indications for Clozapine.The Journal of clinical psychiatry · 2024Article
- Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol.JMIR research protocols · 2024Article
- Functional magnetic resonance imaging in schizophrenia: current evidence, methodological advances, limitations and future directions.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2024Article
- Multi-level barriers and facilitators to implementing evidence-based antipsychotics in the treatment of early-phase schizophrenia.Frontiers in health services · 2024Article
- Cognitive performance at first episode of psychosis and the relationship with future treatment resistance: Evidence from an international prospective cohort study.Schizophrenia research · 2023Article
- Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia.Cureus · 2023Review
- What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians.Schizophrenia (Heidelberg, Germany) · 2023Article
- Five-year illness trajectories across racial groups in the UK following a first episode psychosis.Social psychiatry and psychiatric epidemiology · 2023Article
- Early identification of treatment non-response in first-episode psychosis.European psychiatry : the journal of the Association of European Psychiatrists · 2023Article
- Clinical predictors of antipsychotic treatment resistance: Development and internal validation of a prognostic prediction model by the STRATA-G consortium.Schizophrenia research · 2022Article
Corrections and comments
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Authors and funding
14 authors at 12 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTreatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
aimsThis paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.
methodData were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.
resultsA total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.
conclusionsPrevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
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