Evidence map›Paper›PMID 41742666›Full record

ArticleBJPsych open2026

Treating Unmet Needs in Psychiatry (TUNE-UP): targeted service increases out-patient initiations of clozapine.

Zmarak Ahmad Khan, Ioana Varvari, Valentina Mancini, Chambrez Zita-Zauchenberger, Shashwati Kantor, Jack B Fanshawe, Sharon Musiiwa, Alexandra Pledge, Benjamin Pearce, Saik J G N de La Motte de Broöns de Vauvert and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJPsych open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Zmarak Ahmad KhanPsychiatry, https://ror.org/052gg0110University of Oxford, UK.ORCID https://orcid.org/0000-0001-8247-2017
Ioana VarvariPsychiatry, https://ror.org/052gg0110University of Oxford, UK.
Valentina ManciniPsychiatry, https://ror.org/052gg0110University of Oxford, UK.
Chambrez Zita-ZauchenbergerPsychiatry, https://ror.org/052gg0110University of Oxford, UK.
Shashwati KantorOxford Health NHS Foundation Trust, Oxford, UK.
Jack B FanshawePsychiatry, https://ror.org/052gg0110University of Oxford, UK.
Sharon MusiiwaOxford Health NHS Foundation Trust, Oxford, UK.
Alexandra PledgeOxford Health NHS Foundation Trust, Oxford, UK.
Benjamin PearceOxford Health NHS Foundation Trust, Oxford, UK.
Saik J G N de La Motte de Broöns de VauvertWarneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
Digby QuestedOxford Health NHS Foundation Trust, Oxford, UK.
Daniel MaughanOxford Health NHS Foundation Trust, Oxford, UK.
Joseph Baskerville-ButlerOxford Health NHS Foundation Trust, Oxford, UK.
Philip McGuirePsychiatry, https://ror.org/052gg0110University of Oxford, UK.
Oliver D HowesPsychosis Studies, South London and Maudsley Mental Health NHS Trust, London, UK.ORCID https://orcid.org/0000-0002-2928-1972
Toby PillingerPsychosis Studies, South London and Maudsley Mental Health NHS Trust, London, UK.
Robert A McCutcheonPsychiatry, https://ror.org/052gg0110University of Oxford, UK.ORCID https://orcid.org/0000-0003-1102-2566

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this.

aimsTo describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates.

methodWe reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS).

resultsFifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04-20.2,

conclusionsA specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community.

Indexed as

antipsychoticscommunity mental health teamsgeneral adult psychiatryout-patient treatmentPsychotic disorders/schizophrenia

Identifiers

PMID41742666
PMCPMC12963841

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.