Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study.  In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia

Pai, NB

Vella, SC

English

Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study. In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia

Vella, Shae-Leigh C

Pai, Nagesh Brahmavar

Research Online

University of Wollongong Research Online Graduate School of Medicine - Papers (Archive) Faculty of Science, Medicine and Health 1-1-2012 Prevalence Prescription: Prescribing practices of clozapine in Australia between 2005 2010 Shae-Leigh C. Vella University of Wollongong, vella@uow.edu.au Nagesh Brahmavar Pai University of Wollongong, nagesh@uow.edu.au Follow this and additional works at: https://ro.uow.edu.au/medpapers  Part of the Medicine and Health Sciences Commons Citation Vella, Shae-Leigh C. and Pai, Nagesh Brahmavar, 2012, Prevalence Prescription: Prescribing practices of clozapine in Australia between 2005 2010, 1-2. https://ro.uow.edu.au/medpapers/285 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: research-pubs@uow.edu.au Prevalence Prescription: Prescribing practices of clozapine in Australia between 2005 2010 Abstract Clozapine is an anti-psychotic used to treat refractory schizophrenia. This study reviews the rates of clozapine prescription for refractory schizophrenia in a region of Australia and compares the prescribing patterns to the estimated prevalence rates of refractory schizophrenia in the region. Utilising a pharmacoepidemiological approach; the results indicated that only 8.4% of the individuals estimated to be suffering from refractory schizophrenia in the region were prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to the conclusion of the study. In conclusion it is evident that clozapine is widely under-prescribed in this area of Australia. Keywords practices, clozapine, australia, between, 2005, prevalence, 2010, prescription, prescribing Disciplines Medicine and Health Sciences Publication Details Vella, S. C. Pai, N. Brahmavar. (2012). Prevalence Prescription: Prescribing practices of clozapine in Australia between 2005 2010. Online Journal of Health and Allied Sciences, 11 (1), 1-2. This journal article is available at Research Online: https://ro.uow.edu.au/medpapers/285  Original Article:Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010Shae-Leigh C. Vella, Nagesh B. Pai,Graduate School of Medicine, University of Wollongong, New South Wales, Australia 2522.Address for Correspondence:Shae-Leigh C. Vella,Graduate School of Medicine,University of Wollongong,New South Wales,Australia 2522. E-mail: vella@uow.edu.auCitation: Vella SC, Pai NB. Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010. Online J Health Allied Scs. 2012;11(1):6URL: http://www.ojhas.org/issue41/2012-1-6.htmOpen Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.htmlSubmitted: Jan 3, 2012; Accepted: Mar 27, 2012; Published: Apr 15, 2012Abstract:  Clozapine is an anti-psychotic used to treat refract-ory schizophrenia.  This  study reviews  the  rates  of  clozapine prescription  for  refractory schizophrenia  in  a  region  of  Aus-tralia  and compares  the  prescribing  patterns to  the  estimated prevalence rates of refractory schizophrenia in the region. Util-ising  a  pharmacoepidemiological  approach;  the  results  indic-ated that only 8.4% of the individuals estimated to be suffering from  refractory  schizophrenia  in  the  region  were  prescribed clozapine between 2005 and 2010, with only 4.1% continuing clozapine to  the conclusion  of  the study.  In  conclusion  it  is evident that clozapine is widely under-prescribed in this area of Australia.Key  Words: Clozapine;  Treatment-resistant  schizophrenia; Prevalence rates; AustraliaIntroduction:Schizophrenia is a chronic and debilitating mental disorder that afflicts  approximately  1%  of  the  population  worldwide.(1) Schizophrenia is primarily treated through the use of pharmaco-logical  treatments.  However  not  all  patients who suffer from schizophrenia  respond  well  to  pharmacological  interventions. Approximately  30%  of  individuals  who  suffer  from  schizo-phrenia have a poor response to typical or novel atypical treat-ments.(2,3) That is these patients suffer from treatment-resist-ant or refractory schizophrenia.Clozapine an atypical or second generation anti-psychotic treat-ment has been proven to be extremely effective in the treatment of  refractory  schizophrenia.(2,4,5)  Moreover  clozapine  is  the only anti-psychotic treatment that is endorsed to treat refractory schizophrenia.(6) Specifically Wheeler et al (5) in a large natur-alistic study found that continued clozapine treatment  lead to improved  functional  and  clinical  outcomes.  That  is  patients made improvements in independent living and vocational activ-ities coupled with a reduction in the need for compulsory treat-ment and hospitalisations. Additionally numerous studies have demonstrated a  significant  reduction  in  suicide  rates  and ag-gressive behaviour among those taking clozapine.(7) Further-more clozapine has also been shown to be cost-effective in the treatment of refractory schizophrenia.(5)However the benefits of clozapine therapy come at a high cost due to the drugs high side effect burden.(8) Some of the more significant side effects include weight gain, hypotension, tachy-cardia, agranulocytosis, myocarditis, cardiomyopathy and seda-tion.(9) Although clozapine has a high side effect burden; for patients suffering from treatment-resistant schizophrenia cloza-pine is their last hope to manage their illness and live a ‘nor-mal’ life. It is apparent that even with the adverse side effects clozapine treatment can cause, clozapine therapy can have a significantly beneficial impact on the lives of people with refractory schizo-phrenia. However there is disparity in the reported prescription rates between studies; as numerous studies have reported that clozapine treatment is underutilised.(10) Whereas others have reported that clozapine is well utilised and the rates of prescrip-tion lie within the realm of the estimated prevalence rates of re-fractory schizophrenia.(11) Therefore this paper investigates the prescription of clozapine in  a  region  of  New South  Wales  (NSW),  Australia  between 2005 and 2010.  In order to ascertain whether clozapine therapy is being prescribed at a rate that reflects the predicted preval-ence  of  refractory  schizophrenia  in  the  region.  As it  is  only through reports detailing the ‘real world’ usage of anti-psychot-ics in clinical practice that future research can be shaped (12), as well as highlighting issues of importance to clinicians.Methodology:This study is a retrospective review of the prescribing practices of clozapine for the treatment of schizophrenia in a region of NSW, Australia for the time period between 2005 and 2010. The archival data on the rates of the prescription of clozapine are  compared to  the  estimated  prevalence  rates  of  refractory schizophrenia in the area.This study is based on data from region of NSW, Australia that covers approximately 6631 square kilometres and 13 different local Government areas. The most recent census in 2006 repor-ted the population in the region to be 1.1 million. This is a total of 20% of the population of the state of NSW. The socio-eco-nomic  status  of  the  area is  comparatively less  disadvantaged than the rest of  NSW.  However  there is significant  variation between the 13 local Government areas on this indicator. Results:Estimated Prevalence Rates of Schizophrenia & Refractory SchizophreniaIt is well known that schizophrenia has a global prevalence rate of 1% (1), therefore based upon the region’s population of 1.1 million it would be expected that 11’000 individuals in the re-gion  are suffering from schizophrenia.  Furthermore  it  is also apparent from previous work that of those individuals afflicted with schizophrenia approximately 30% will have refractory or treatment  resistant  schizophrenia  (2;  3).  Therefore  from the 1Online Journal of Health and Allied SciencesPeer Reviewed, Open Access, Free Online JournalPublished Quarterly :  Mangalore, South India : ISSN 0972-5997Volume 11, Issue 1; Jan-Mar 2012This work is licensed under aCreative Commons Attribution-No Derivative Works 2.5 India Licenseabove  prevalence  rate,  a  total  3’300  individual’s  with  treat-ment-resistant schizophrenia are estimated to reside in the area.Clozapine Prescription in the RegionBetween the period of 2005 and 2010 a total of 277 individuals within  the  region  were  prescribed clozapine.  This  is  a  mere 8.4% of  the individuals  estimated to be suffering from treat-ment-resistant schizophrenia in the region.  Furthermore 141 of these individuals  ceased clozapine treatment  during this  time with only 136 patients continuing treatment to the present time. Therefore only a total of 4.1% of those estimated to be suffer-ing from refractory schizophrenia are currently receiving cloza-pine treatment in the area. This implies that the vast majority 95.9%  or  3’164  individuals  estimated  to  be  suffering  from treatment-resistant schizophrenia in the region are not receiving appropriate or the superior evidenced based treatment for their condition.Discussion:It is evident from the above study that the prescription of cloza-pine in this region of NSW, Australia for the treatment of re-fractory  schizophrenia  is  immensely  under-prescribed  based upon  the  estimated  prevalence  rates  of  treatment-resistant schizophrenia in the area. As out of the 3’300 individuals es-timated to be suffering from treatment-resistant schizophrenia in  the  area  only  8.4%  or  277  patients  had  been  prescribed clozapine. Furthermore only 4.1% or 136 patients had contin-ued clozapine treatment in the reported time period. These findings are in accordance with findings in the United States (U.S.) where clozapine prescriptions only accounted for 5% of all anti-psychotics prescribed.(6,13) Whereas Conley et al  (13)  study  reported  that  clozapine  was  used  significantly more often in Australia in comparison to Maryland in the U.S. However the study assessed clozapine use in a different state of Australia; thus displaying the disparity in prescribing patterns even in the same country. Similarly Fayek (14) reported that the rates  of  prescribing  clozapine  were  significantly  different throughout  the United Kingdom.  However other studies have reported that clozapine is well utilised.(11,15,16) Therefore it is evident that there are inconsistencies both in the practice of pre-scribing clozapine as well as the reports of prescribing patterns in the literature. The under utilisation and disparity in the prescribing practices pertaining to clozapine; an evidenced based treatment for re-fractory schizophrenia not  only results in significant costs  to patients, their families, and society, it leads to significant costs for the health system. Wheeler et al (5) reports that the medical costs that result from patients with refractory schizophrenia are high and account for the majority of the overall cost of treating schizophrenia due to hospitalisations. Furthermore Drew et al (17) found that long term use of clozapine (3-5 years) accoun-ted for a $12 000 reduction in costs per patient per annum in Australia. It is thought that the low prescription rates of clozapine in com-parison to the estimated prevalence rates may be related to the knowledge and attitudes of prescribing clinicians. Nielsen et al (10) conducted a study in Denmark and found that many psy-chiatrists were reluctant to prescribe clozapine and had limited knowledge on the use of clozapine. Furthermore the low pre-scription rates could pertain to the actual or perceived logistical support for the necessary monitoring of patients on clozapine. Future research needs to systematically address this issue by as-sessing  the  beliefs,  knowledge  and  attitudes  of  prescribing clinicians towards clozapine. Such an endeavour would allow for the delineation of the reasons behind the low prescription rates  of  clozapine.  This  would  facilitate  the  development  of solutions to deal with the prevailing issues. Therefore bettering the  prognosis  for  those  patients  suffering  from  refractory schizophrenia,  helping  their  families  and  society;  as  well  as lowering the health related costs of caring for these individuals.References:1. Capuano B, Crosby IT, Lloyd EJ. Schizophrenia: Genesis, receptorology, and current therapeutics. Current Medicin-al Chemistry. 2002;9:521-548.2. Conley RR, Buchanan RW. Evaluation of treatment-res-istant  schizophrenia.  Schizophrenia  Bulletin. 1997;23(4):663-674.3. Semiz  UB,  cetin  M,  Basoglu  C,  Ebrinc  S,  Uzun  O, Herken H, Balibey H, Algul A, Ates A. Clinical predict-ors  of therapeutic response  to clozapine in a sample  of Turkish  patients  with  treatment-resistant  schizophrenia. Progress  in  Neuro-psychopharmacology  &  Biological  Psychiatry. 2007;31:1330-1336. 4. Angermyer MC, Loffler W, Muller P, Schulze B, Priebe S. Patients’ and relatives’ assessment of clozapine treat-ment. Psychological Medicine. 2001;31:509-517.5. Wheeler A, Humberstone V, Robinson G. Outcomes for schizophrenia  patients  with  clozapine  treatment:  how good  does  it  get?  Journal  of  Psychopharmacology. 2009;23(8):957-965.6. Kelly DL, Kreyenbuhl  J,  Buchanan RW,  Malhotra AK. Why not  clozapine?  Clinical  Schizophrenia.  2007;1:92-95.7. Henneen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis.  Schizophrenia Research 2005;73:139-145.8. Young CR, Bowers MB, Mazure CM. Management of the adverse  effects  of  clozapine.  Schizophrenia  Bulletin 1998;24(3): 381-390.9. Reznik I, Volchek L, Mester R, Kotler M, Sarova-Pinhas I, Spivak B, Weizman A. Myotoxicity and neurotoxicity during clozapine treatment.  Clinical Neuropharmacology 2000;23(5):276-280.10. Nielsen J, Dahm M, Lublin H, Taylor D. Psychiatrists at-titude towards and knowledge of schizophrenia treatment. Journal of Psychopharmacology. 2010;24(7):965-971.11. Wheeler A, Humberstone V, Robinson G. Trends in anti-psychotic prescribing in schizophrenia in Auckland. Aus-tralasian Journal of Psychiatry 2006;14(2):169-174.12. Marder  SR.  Can  clinical  practice  guide  a  research agenda? Schizophrenia Bulletin. 2002;28(1):127-129.13. Conley RR, Kelly DL, Lambert TJ, Love RC. Comparis-on of clozapine use in Maryland and in Victoria Australia. Psychiatric Services. 2005;56(3):320-323.14. Fayek M, Flowers C, Signorelli  D, Simpson G. Psycho-pharmacology:  underuse of evidence-based treatments in psychiatry. Psychiatric Services. 2003;54(11):1453-1456.15. Mond  J,  Morice  R,  Owen  C,  Korten  A.  Use  of  anti-psychotic medications in Australia between July 1995 and December 2001. Australian and New Zealand Journal of  Psychiatry. 2002;37:55-61.16. Weinbrenner S, Assion HJ, Stargardt T, Busse R, Juckel G,  Gericke  CA.  Drug  prescription  patterns  in  schizo-phrenia  outpatients:  analysis  of  data  from  a  German health insurance fund. Pharmacopsychiatry 2008;41:1-6.  17. Drew LRH, Griffiths KM, Hodgson DM. A five year fol-low-up study of the use of clozapine in community prac-tice. Australian and New Zealand Journal of Psychiatry 2002;36:780-786.2

Prevalence  Prescription: Prescribing practices of clozapine in Australia between 2005  2010

Cognitive Sciences ePrint Archive

 Original Article:
Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 
2010
Shae-Leigh C. Vella, Nagesh B. Pai,
Graduate School of Medicine, University of Wollongong, New South Wales, Australia 2522.
Address for Correspondence:
Shae-Leigh C. Vella,
Graduate School of Medicine,
University of Wollongong,
New South Wales,
Australia 2522. 
E-mail: vella@uow.edu.au
Citation: Vella SC, Pai NB. Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010. Online 
J Health Allied Scs. 2012;11(1):6
URL: http://www.ojhas.org/issue41/2012-1-6.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Jan 3, 2012; Accepted: Mar 27, 2012; Published: Apr 15, 2012
Abstract:  Clozapine is an anti-psychotic used to treat refract-
ory schizophrenia.  This  study reviews  the  rates  of  clozapine 
prescription  for  refractory schizophrenia  in  a  region  of  Aus-
tralia  and compares  the  prescribing  patterns to  the  estimated 
prevalence rates of refractory schizophrenia in the region. Util-
ising  a  pharmacoepidemiological  approach;  the  results  indic-
ated that only 8.4% of the individuals estimated to be suffering 
from  refractory  schizophrenia  in  the  region  were  prescribed 
clozapine between 2005 and 2010, with only 4.1% continuing 
clozapine to  the conclusion  of  the study.  In  conclusion  it  is 
evident that clozapine is widely under-prescribed in this area of 
Australia.
Key  Words: Clozapine;  Treatment-resistant  schizophrenia; 
Prevalence rates; Australia
Introduction:
Schizophrenia is a chronic and debilitating mental disorder that 
afflicts  approximately  1%  of  the  population  worldwide.(1) 
Schizophrenia is primarily treated through the use of pharmaco-
logical  treatments.  However  not  all  patients who suffer from 
schizophrenia  respond  well  to  pharmacological  interventions. 
Approximately  30%  of  individuals  who  suffer  from  schizo-
phrenia have a poor response to typical or novel atypical treat-
ments.(2,3) That is these patients suffer from treatment-resist-
ant or refractory schizophrenia.
Clozapine an atypical or second generation anti-psychotic treat-
ment has been proven to be extremely effective in the treatment 
of  refractory  schizophrenia.(2,4,5)  Moreover  clozapine  is  the 
only anti-psychotic treatment that is endorsed to treat refractory 
schizophrenia.(6) Specifically Wheeler et al (5) in a large natur-
alistic study found that continued clozapine treatment  lead to 
improved  functional  and  clinical  outcomes.  That  is  patients 
made improvements in independent living and vocational activ-
ities coupled with a reduction in the need for compulsory treat-
ment and hospitalisations. Additionally numerous studies have 
demonstrated a  significant  reduction  in  suicide  rates  and ag-
gressive behaviour among those taking clozapine.(7) Further-
more clozapine has also been shown to be cost-effective in the 
treatment of refractory schizophrenia.(5)
However the benefits of clozapine therapy come at a high cost 
due to the drugs high side effect burden.(8) Some of the more 
significant side effects include weight gain, hypotension, tachy-
cardia, agranulocytosis, myocarditis, cardiomyopathy and seda-
tion.(9) Although clozapine has a high side effect burden; for 
patients suffering from treatment-resistant schizophrenia cloza-
pine is their last hope to manage their illness and live a ‘nor-
mal’ life. 
It is apparent that even with the adverse side effects clozapine 
treatment can cause, clozapine therapy can have a significantly 
beneficial impact on the lives of people with refractory schizo-
phrenia. However there is disparity in the reported prescription 
rates between studies; as numerous studies have reported that 
clozapine treatment is underutilised.(10) Whereas others have 
reported that clozapine is well utilised and the rates of prescrip-
tion lie within the realm of the estimated prevalence rates of re-
fractory schizophrenia.(11) 
Therefore this paper investigates the prescription of clozapine 
in  a  region  of  New South  Wales  (NSW),  Australia  between 
2005 and 2010.  In order to ascertain whether clozapine therapy 
is being prescribed at a rate that reflects the predicted preval-
ence  of  refractory  schizophrenia  in  the  region.  As it  is  only 
through reports detailing the ‘real world’ usage of anti-psychot-
ics in clinical practice that future research can be shaped (12), 
as well as highlighting issues of importance to clinicians.
Methodology:
This study is a retrospective review of the prescribing practices 
of clozapine for the treatment of schizophrenia in a region of 
NSW, Australia for the time period between 2005 and 2010. 
The archival data on the rates of the prescription of clozapine 
are  compared to  the  estimated  prevalence  rates  of  refractory 
schizophrenia in the area.
This study is based on data from region of NSW, Australia that 
covers approximately 6631 square kilometres and 13 different 
local Government areas. The most recent census in 2006 repor-
ted the population in the region to be 1.1 million. This is a total 
of 20% of the population of the state of NSW. The socio-eco-
nomic  status  of  the  area is  comparatively less  disadvantaged 
than the rest of  NSW.  However  there is significant  variation 
between the 13 local Government areas on this indicator. 
Results:
Estimated Prevalence Rates of Schizophrenia & Refractory 
Schizophrenia
It is well known that schizophrenia has a global prevalence rate 
of 1% (1), therefore based upon the region’s population of 1.1 
million it would be expected that 11’000 individuals in the re-
gion  are suffering from schizophrenia.  Furthermore  it  is also 
apparent from previous work that of those individuals afflicted 
with schizophrenia approximately 30% will have refractory or 
treatment  resistant  schizophrenia  (2;  3).  Therefore  from the 
1
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 11, Issue 1; Jan-Mar 2012
This work is licensed under a
Creative Commons Attribution-
No Derivative Works 2.5 India License
above  prevalence  rate,  a  total  3’300  individual’s  with  treat-
ment-resistant schizophrenia are estimated to reside in the area.
Clozapine Prescription in the Region
Between the period of 2005 and 2010 a total of 277 individuals 
within  the  region  were  prescribed clozapine.  This  is  a  mere 
8.4% of  the individuals  estimated to be suffering from treat-
ment-resistant schizophrenia in the region.  Furthermore 141 of 
these individuals  ceased clozapine treatment  during this  time 
with only 136 patients continuing treatment to the present time. 
Therefore only a total of 4.1% of those estimated to be suffer-
ing from refractory schizophrenia are currently receiving cloza-
pine treatment in the area. This implies that the vast majority 
95.9%  or  3’164  individuals  estimated  to  be  suffering  from 
treatment-resistant schizophrenia in the region are not receiving 
appropriate or the superior evidenced based treatment for their 
condition.
Discussion:
It is evident from the above study that the prescription of cloza-
pine in this region of NSW, Australia for the treatment of re-
fractory  schizophrenia  is  immensely  under-prescribed  based 
upon  the  estimated  prevalence  rates  of  treatment-resistant 
schizophrenia in the area. As out of the 3’300 individuals es-
timated to be suffering from treatment-resistant schizophrenia 
in  the  area  only  8.4%  or  277  patients  had  been  prescribed 
clozapine. Furthermore only 4.1% or 136 patients had contin-
ued clozapine treatment in the reported time period. 
These findings are in accordance with findings in the United 
States (U.S.) where clozapine prescriptions only accounted for 
5% of all anti-psychotics prescribed.(6,13) Whereas Conley et 
al  (13)  study  reported  that  clozapine  was  used  significantly 
more often in Australia in comparison to Maryland in the U.S. 
However the study assessed clozapine use in a different state of 
Australia; thus displaying the disparity in prescribing patterns 
even in the same country. Similarly Fayek (14) reported that the 
rates  of  prescribing  clozapine  were  significantly  different 
throughout  the United Kingdom.  However other studies have 
reported that clozapine is well utilised.(11,15,16) Therefore it is 
evident that there are inconsistencies both in the practice of pre-
scribing clozapine as well as the reports of prescribing patterns 
in the literature. 
The under utilisation and disparity in the prescribing practices 
pertaining to clozapine; an evidenced based treatment for re-
fractory schizophrenia not  only results in significant costs  to 
patients, their families, and society, it leads to significant costs 
for the health system. Wheeler et al (5) reports that the medical 
costs that result from patients with refractory schizophrenia are 
high and account for the majority of the overall cost of treating 
schizophrenia due to hospitalisations. Furthermore Drew et al 
(17) found that long term use of clozapine (3-5 years) accoun-
ted for a $12 000 reduction in costs per patient per annum in 
Australia. 
It is thought that the low prescription rates of clozapine in com-
parison to the estimated prevalence rates may be related to the 
knowledge and attitudes of prescribing clinicians. Nielsen et al 
(10) conducted a study in Denmark and found that many psy-
chiatrists were reluctant to prescribe clozapine and had limited 
knowledge on the use of clozapine. Furthermore the low pre-
scription rates could pertain to the actual or perceived logistical 
support for the necessary monitoring of patients on clozapine. 
Future research needs to systematically address this issue by as-
sessing  the  beliefs,  knowledge  and  attitudes  of  prescribing 
clinicians towards clozapine. Such an endeavour would allow 
for the delineation of the reasons behind the low prescription 
rates  of  clozapine.  This  would  facilitate  the  development  of 
solutions to deal with the prevailing issues. Therefore bettering 
the  prognosis  for  those  patients  suffering  from  refractory 
schizophrenia,  helping  their  families  and  society;  as  well  as 
lowering the health related costs of caring for these individuals.
References:
1. Capuano B, Crosby IT, Lloyd EJ. Schizophrenia: Genesis, 
receptorology, and current therapeutics. Current Medicin-
al Chemistry. 2002;9:521-548.
2. Conley RR, Buchanan RW. Evaluation of treatment-res-
istant  schizophrenia.  Schizophrenia  Bulletin. 
1997;23(4):663-674.
3. Semiz  UB,  cetin  M,  Basoglu  C,  Ebrinc  S,  Uzun  O, 
Herken H, Balibey H, Algul A, Ates A. Clinical predict-
ors  of therapeutic response  to clozapine in a sample  of 
Turkish  patients  with  treatment-resistant  schizophrenia. 
Progress  in  Neuro-psychopharmacology  &  Biological  
Psychiatry. 2007;31:1330-1336. 
4. Angermyer MC, Loffler W, Muller P, Schulze B, Priebe 
S. Patients’ and relatives’ assessment of clozapine treat-
ment. Psychological Medicine. 2001;31:509-517.
5. Wheeler A, Humberstone V, Robinson G. Outcomes for 
schizophrenia  patients  with  clozapine  treatment:  how 
good  does  it  get?  Journal  of  Psychopharmacology. 
2009;23(8):957-965.
6. Kelly DL, Kreyenbuhl  J,  Buchanan RW,  Malhotra AK. 
Why not  clozapine?  Clinical  Schizophrenia.  2007;1:92-
95.
7. Henneen J, Baldessarini RJ. Suicidal risk during treatment 
with clozapine: a meta-analysis.  Schizophrenia Research 
2005;73:139-145.
8. Young CR, Bowers MB, Mazure CM. Management of the 
adverse  effects  of  clozapine.  Schizophrenia  Bulletin 
1998;24(3): 381-390.
9. Reznik I, Volchek L, Mester R, Kotler M, Sarova-Pinhas 
I, Spivak B, Weizman A. Myotoxicity and neurotoxicity 
during clozapine treatment.  Clinical Neuropharmacology 
2000;23(5):276-280.
10. Nielsen J, Dahm M, Lublin H, Taylor D. Psychiatrists at-
titude towards and knowledge of schizophrenia treatment. 
Journal of Psychopharmacology. 2010;24(7):965-971.
11. Wheeler A, Humberstone V, Robinson G. Trends in anti-
psychotic prescribing in schizophrenia in Auckland. Aus-
tralasian Journal of Psychiatry 2006;14(2):169-174.
12. Marder  SR.  Can  clinical  practice  guide  a  research 
agenda? Schizophrenia Bulletin. 2002;28(1):127-129.
13. Conley RR, Kelly DL, Lambert TJ, Love RC. Comparis-
on of clozapine use in Maryland and in Victoria Australia. 
Psychiatric Services. 2005;56(3):320-323.
14. Fayek M, Flowers C, Signorelli  D, Simpson G. Psycho-
pharmacology:  underuse of evidence-based treatments in 
psychiatry. Psychiatric Services. 2003;54(11):1453-1456.
15. Mond  J,  Morice  R,  Owen  C,  Korten  A.  Use  of  anti-
psychotic medications in Australia between July 1995 and 
December 2001. Australian and New Zealand Journal of  
Psychiatry. 2002;37:55-61.
16. Weinbrenner S, Assion HJ, Stargardt T, Busse R, Juckel 
G,  Gericke  CA.  Drug  prescription  patterns  in  schizo-
phrenia  outpatients:  analysis  of  data  from  a  German 
health insurance fund. Pharmacopsychiatry 2008;41:1-6.  
17. Drew LRH, Griffiths KM, Hodgson DM. A five year fol-
low-up study of the use of clozapine in community prac-
tice. Australian and New Zealand Journal of Psychiatry 
2002;36:780-786.
2


Prevalence & Prescription: Prescribing Practices of Clozapine in Australia between 2005 & 2010

Abstract

Similar works

Full text

Available Versions

Research Online

Cognitive Sciences ePrint Archive

CogPrints Cognitive Sciences Eprint Archive

Directory of Open Access Journals