Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002-2012).
OBJECTIVE
We examined the time trends and correlates of clozapine use in schizophrenia patients in China.


METHODS
A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were interviewed in 2002, 2006 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and quality of life (QOL) were recorded in a standardized fashion.


RESULTS
Clozapine was used in 32.9% of the whole sample; with corresponding figures of 39.7%, 32.5% and 26.4% in 2002, 2006 and 2012 (p<0.001). Families of clozapine users had lower satisfaction with treatment than those of the non-clozapine group, without significant differences with respect to patients' treatment satisfaction and mental or physical QOL. In multiple logistic regression analyses, compared to the non-clozapine group, patients on clozapine had an earlier age of onset, longer illness duration, more global illness severity and drug-induced central nervous system, gastrointestinal and other side effects, lower antipsychotic doses, less delusions and hallucinations, more negative symptoms, were more likely male, inpatients, to have a family history of psychiatric disorders, receive treatments in regional centers and receive antipsychotic polypharmacy, but less likely to have health insurance and receive first-generation antipsychotics and benzodiazepines (R(2)=0.498, p<0.001).


CONCLUSIONS
Clozapine was used in one-third of schizophrenia patients in China, with decreasing frequency since 2002. Patients prescribed clozapine had multiple markers of greater global illness severity/chronicity and decreased satisfaction with treatment by the families, but similar QOL and less delusions and hallucinations than patients not prescribed clozapine.
The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
Qian
Q
Li
The National Clinical Research Center for Mental Disorders (Beijing Anding Hospital) & Department of Psychiatry, Capital Medical University & Center of Depression, Beijing Institute for Brain Disorders, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China. Electronic address: xyutly@gmail.com.
Yu-Tao
YT
Xiang
The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
Yun-Ai
YA
Su
The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
Liang
L
Shu
The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
Xin
X
Yu
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.
Christoph U
CU
Correll
School of Psychiatry & Clinical Neuroscience, University of Western Australia, Perth, Australia.
Gabor S
GS
Ungvari
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
Helen F K
HF
Chiu
Psychiatric Hospital, Guangzhou, China.
Cui
C
Ma
Department of Psychiatry, Renmin Hospital, Wuhan University, Wuhan, China.
Gao-Hua
GH
Wang
The First Hospital of Shanxi Medical University, Shanxi Province, China.
Pei-Shen
PS
Bai
West China Hospital, Sichuan University, China.
Tao
T
Li
Neuropsychiatric Hospital, Jilin, China.
Li-Zhong
LZ
Sun
Mental Health Center, Xi-an, China.
Jian-Guo
JG
Shi
Jiangxi Psychiatric Hospital, Jiangxi, China.
Xian-Sheng
XS
Chen
Suzhou Guangji Hospital, Suzhou, China.
Qi-Yi
QY
Mei
Hebei Mental Health Center, Hebei, China.
Ke-Qing
KQ
Li
The National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & Peking University Institute of Mental Health & The Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China. Electronic address: si.tian-mei@163.com.
Tian-Mei
TM
Si
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.
John M
JM
Kane
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D013997:Time Factors
D014150:Antipsychotic Agents; D003024:Clozapine
Clozapine; Prescription patterns; Schizophrenia