Clinical correlates of clozapine prescription for schizophrenia in China.
OBJECTIVE
Few studies have investigated the prescription patterns of clozapine in outpatients with schizophrenia in China. It is an important issue due to clozapine's high efficacy and potentially fatal side effect profile. This study examined the use of clozapine and its correlates in China.


METHODS
Three hundred ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in Hong Kong (HK) and Beijing (BJ). Assessment instruments included the Structured Clinical Interview for DSM-IV, Brief Psychiatric Rating Scale, Simpson and Angus Scale of Extrapyramidal Symptoms, Barnes Akathisia Rating Scale and the Hong Kong and Mainland China World Health Organization Quality of Life Schedule-Brief version. Assessments were performed by the same investigator in both sites.


RESULTS
Clozapine was prescribed to 15.6% of (n = 62) patients. There was a wide inter-site variation between HK and BJ. Use of clozapine was associated with age, age at onset, extrapyramidal side effects (EPS), having health insurance, use of depot and typical antipsychotic and anticholinergic drugs and benzodiazepines as well as history of suicidal attempts. On multiple logistic regression analysis, the number of hospitalizations, site (HK vs. BJ), use of typical antipsychotics, polypharmacy and co-prescription with anticholinergics were significantly associated with the prescription of clozapine. No significant differences were found between the clozapine and non-clozapine groups with regard to any of the quality of life domains.


CONCLUSIONS
A combination of economical and clinical factors, health policies and the characteristics of the treatment settings plays important roles in determining clozapine use. Clozapine appears to have little significant influence on quality of life in clinical stable Chinese patients with schizophrenia.
Xiang
Yu-Tao
YT
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China. xyutly@cuhk.edu.hk
Weng
Yong-Zhen
YZ
Leung
Chi-Ming
CM
Tang
Wai-Kwong
WK
Ungvari
Gabor Sandor
GS
D000328:Adult; D000367:Age Factors; D017109:Akathisia, Drug-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects; D003431:Cross-Cultural Comparison; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013223:Statistics as Topic; D013405:Suicide / Q000523:psychology; D000092864:Suicide Prevention
D014150:Antipsychotic Agents; D003024:Clozapine