Investigating of the Experience of Subjective Well-Being of Clozapine Use in Patients with Treatment-Resistant Schizophrenia: A Mixed Method Study.

Background and Objective: While clozapine is an effective medication for treatment-resistant schizophrenia (TRS), adherence to treatment is often the focus of concern. The subjective experiences of patients with TRS treated with clozapine can be helpful in managing the concern related to its use. Therefore, this study aimed to explore the subjective well-being of patients with TRS treated with clozapine. Materials and Methods: This study was conducted using a mixed-methods approach. In the quantitative part, data was gathered using two questionnaires, completed by 42 patients with TRS treated with clozapine. In the qualitative part, semi-structured interviews were conducted with seven patients to gather their experiences. The quantitative data were analyzed using descriptive statistics, and content analysis was used for analyzing qualitative data. Results: Half of the participants in the quantitative part were female, and half were male. Their average age was 40.94 ± 10.89 years. The average duration of clozapine use among these patients was 71.66 ± 118.60 months. Study participants reported both positive and negative changes in their symptoms after clozapine use. The most substantial improvements were reported in mood (71.4% "better"), sleep (64.3% "better"), and quality of life (45.2% "much better"). Hypersalivation (21.4% "much worse"), abdominal pain (81% "worse"), and unusual sensations (64.3% "worse") were the most frequent negative experiences. The results of the qualitative analysis also showed that participants had subjective pleasant and unpleasant experiences. Pleasant experiences were related to symptom reduction and personal and family satisfaction with clozapine use, while unpleasant experiences were related to side effects and other issues with clozapine use. Conclusion: The quantitative and qualitative results are strongly interconnected, revealing that subjective experiences of patients with TRS who used clozapine range from positive experiences, such as improved quality of life, to negative experiences, such as adverse side effects and contextual barriers. The results can be helpful for clinicians in the management of TRS patients treated with clozapine. Highlighting positive changes to patients and their families can increase adherence to treatment, and managing negative changes and adverse side effects can impact treatment outcomes.