ArticleSchizophrenia bulletin2026
Identifying Clinical Characteristics of Young People with Treatment-Resistant Schizophrenia Undergoing Community Initiation of Clozapine.
Article in Schizophrenia bulletin, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
Funding
Abstract
background and hypothesisThe requirement for hospital admission to initiate clozapine presents a health-systems-related barrier to clozapine prescription and contributes to its underutilization in treatment-resistant schizophrenia (TRS). This study aimed to examine the clinicodemographic characteristics associated with treatment settings for clozapine initiation within a first-episode psychosis (FEP) cohort attending an early intervention in psychosis service. STUDY
designSecondary analysis of a retrospective cohort study of 1220 young people presenting with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 2011 - 2017. STUDY
resultsNinety-one cases of TRS were identified and included in the analysis, with 70 commencing clozapine, of whom 67 had a commencement setting identified. Over half (n = 36, 53.7%) commenced clozapine in the community. When compared to the hospital initiation group, the community initiation group were less likely to have had a hospital admission at baseline (odds ratio (OR) 0.26, 95%CI, 0.09-0.87) or an involuntary admission during the 2 year episode of care with EPPIC (OR 0.25, 95%CI, 0.09-0.70). The community initiated group had presented with less severe delusion scores on short form Scale for Assessment of Positive Symptoms at baseline (mean 3.08 vs 3.94, P = .031). First generation migrants were less likely to initiate clozapine in the community (OR 0.29, 95%CI, 0.09-0.97). The community initiation group also had reduced odds of clozapine discontinuation until discharge from EPPIC (OR 0.22, 95%CI, 0.06-0.76).
conclusionCommunity initiation provides an alternative route to clozapine treatment and may be associated with a reduced rate of clozapine discontinuation.
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