Abstract
Background Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in Sao Paulo, Brazil. Methods A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients’ clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in Sao Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.
Highlights
Antipsychotic drugs are the mainstay of the treatment of schizophrenia, but they are effective in the majority of patients, approximately 30% of this population has little or no benefit from conventional antipsychotic treatment[1]
Since clozapine is the best treatment for treatment-resistant schizophrenia (TRS) patients, the aim of the present study is to investigate wether clozapine is and adequately prescribed for patients with TRS as well as to evaluate the patterns of antipsychotic drugs prescription for patients with TRS in the Centros de Atenção Psicossocial (CAPS) of São Paulo
Psychiatrists from the CAPS Itaim Paulista were not able to cooperate with the study due to time constraints; we have worked with a total of 1,215 patients (Figure 1)
Summary
Antipsychotic drugs are the mainstay of the treatment of schizophrenia, but they are effective in the majority of patients, approximately 30% of this population has little or no benefit from conventional antipsychotic treatment[1] These patients have more severe levels of psychopathology, greater number of episodes of illness and hospitalizations, and poorer quality of life compared to those who respond to treatment[2,3]. Brazil’s Constitution establishes health as a right for all and a duty of the State, in our country most of the patients with TRS are treated in public community mental health centers, named Centros de Atenção Psicossocial (CAPS), (Psychosocial Care Centers) These centers are located nationwide and assist people with the most severe mental disorders, providing intensive and multidisciplinary care, with focus on medical treatment and social reinsertion through access to labor, civil rights and leisure. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers
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