What Is the Place of Clozapine in the Treatment of Early Psychosis in Canada?
Research and development of early intervention (EI) services for first-episode psychosis have brought much-needed transformation of service delivery for this serious mental disorder to many jurisdictions. The effectiveness of the EI model of service delivery is contingent on timely access to all evidence-informed treatment interventions, including a rational approach to pharmacotherapy. In this perspective paper, we present a brief review of the well-established effectiveness of clozapine in patients who clearly show lack of response to regular antipsychotic therapy. We concentrate, in particular, on the need to identify eligibility for clozapine therapy very early on following failure of treatment on 2 antipsychotic medications. We suggest that attention to the low use of clozapine in the very early phase of treatment of psychosis may be of particular value, as the response to clozapine at this stage is likely to produce larger benefits in other domains of outcomes because of the greater retention of patients' personal and social agency.
1 Department of Psychiatry, University of British Columbia, Victoria, British Columbia.
Richard
R
Williams
2 Department of Psychiatry, McGill University, Montréal, Québec.|3 Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montréal, Québec.
Ashok
A
Malla
4 Département de Psychiatrie et Neurosciences, Faculté de Médecine de l'Université Laval, Québec, Québec.|5 Clinique Notre-Dame des Victoires, Centre intégré universitaire de la Capitale Nationale, Québec, Québec.
Marc-Andre
MA
Roy
2 Department of Psychiatry, McGill University, Montréal, Québec.|3 Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montréal, Québec.
Ridha
R
Joober
6 Psychiatry, Western University, London, Ontario.|7 Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario.
Rahul
R
Manchanda
8 Dalhousie University, Halifax, Nova Scotia.|9 Nova Scotia Early Psychosis Program, Halifax, Nova Scotia.
Phil
P
Tibbo
10 Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario.
Nicola
N
Banks
11 Complex Mental Illness Program/Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario.|12 Department of Psychiatry, University of Toronto, Toronto, Ontario.
Ofer
O
Agid
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002170:Canada; D003024:Clozapine / Q000627:therapeutic use*; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy*
D014150:Antipsychotic Agents; D003024:Clozapine
clozapine; first episode; treatment resistance psychosis