A five year follow-up study of the use of clozapine in community practice.
OBJECTIVE
To present information about the value of clozapine in treatment-resistant schizophrenia. Data is reported on the use of clozapine in an entire cohort of (42) patients in a community, the Australian Capital Territory. It extends a 3-year study of clinical and financial outcomes to 5 years.


METHODS
Experiences during the 2 years before clozapine was prescribed and those of the 5 years following prescription were compared by a records review, including hospital and hostel bed use and estimated treatment costs. Changes in dose levels, living circumstances and employment status were assessed, and treating psychiatrists reported on side-effects and their impression of clinical change since clozapine was prescribed.


RESULTS
Ten subjects were excluded. The remaining cohort (32 subjects) demonstrated continuing clinical improvement and cost savings during follow-up. Those (22) remaining on clozapine after the five year period showed continuing clinical improvement, reduced hospital admissions and hospital bed usage and significantly large cost savings, and were moderately to markedly improved after 3 years. Only one patient (of 22) showed a slight deterioration in the next two years while 14 showed further improvement. After 5 years, the clinical status of four of the 10 subjects who discontinued clozapine was unchanged or deteriorated compared with their preclozapine status. There were no suicides.


CONCLUSIONS
The findings of continuing clinical improvement and decreased costs after long-term (5 years) use of clozapine supports the selective use of clozapine in community practice.
Drew
Leslie R H
LR
Department of Psychological Medicine, Canberra Clinical School, University of Sydney, City Mental Health Service, Canberra City, Australia. les.drew@act.gov.au
Griffiths
Kathleen M
KM
Hodgson
Donna M
DM
D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001315:Australia; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine