School of Psychology, Institute for Mental Health, University of Birmingham, UK
Rowena Jones
School of Psychology, Institute for Mental Health, University of Birmingham; and Research and Innovation, Birmingham and Solihull Mental Health Foundation Trust, UK
Linda Everard
Research and Innovation, Birmingham and Solihull Mental Health Foundation Trust, UK
Peter B. Jones
University of Cambridge, UK
David Fowler
Department of Psychology, University of Sussex, UK
Joanne Hodgekins
Norwich Medical School, University of East Anglia, UK
Tim Amos
University of Bristol, UK
Nick Freemantle
Institute of Clinical Trials & Methodology, University College London, UK
Vimal Sharma
Faculty of Health and Social Care, University of Chester, UK
Max Marshall
Lancashire Care NHS Foundation Trust, UK
Swaran P. Singh
Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Trust, UK
Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham; School of Psychology, Institute for Mental Health, University of Birmingham; Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Trust, UK
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.