title: Correlates of Clozapine Use after a First Episode of Schizophrenia: Results From a Long-term Prospective Study.
abstract: Earlier commencement of clozapine has been related to a better response in treatment-resistant schizophrenia.
  
  
  
  To identify variables that predict clozapine use after a first episode of schizophrenia (FES).
  
  
  
  Patients with FES and ≤15 days of lifetime antipsychotic treatment were followed up during naturalistic treatment, and the patients who were initiated on clozapine were compared with those receiving non-clozapine antipsychotics for ≥24 months regarding demographic and clinical baseline characteristics, adherence, and relapse patterns during follow-up. Treatment-resistant schizophrenia was defined as two or more antipsychotic trials of adequate dose for ≥6 weeks.
  
  
  
  Twenty-eight patients who used clozapine and 77 non-clozapine antipsychotic users were included. Clozapine was initiated after a mean of 2.5 ± 1.1 adequate antipsychotic trials. Eight of the 28 clozapine-treated patients (28.6 %) began their clozapine treatment during the first 12 months of follow-up (mean 7.1 ± 3.3 months) and their premorbid childhood adjustment was significantly worse than those who started clozapine later (mean 78.5 ± 43.0 months). Compared with non-clozapine users, patients who started clozapine had significantly more relapses in the first 6 months of follow-up prior to clozapine use (35.7 vs. 11.7 %, p = 0.005), and were significantly more likely to have a first relapse despite treatment adherence (38.1 vs. 73.3 %, p = 0.01). In the multivariate analyses, antipsychotic polypharmacy and first relapse despite adherence to antipsychotic treatment independently predicted subsequent clozapine use.
  
  
  
  Clozapine use after a FES was predicted by a first relapse while being adherent to non-clozapine antipsychotics, especially if the first relapse occurred within the first 6 months. Developmental childhood difficulties predicted significantly earlier clozapine use.
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey. alpucok@gmail.com.
authors.forename: Alp
authors.initials: A
authors.lastname: Üçok
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Çıkrıkçılı
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey.
authors.forename: Ceylan
authors.initials: C
authors.lastname: Ergül
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey.
authors.forename: Öznur
authors.initials: Ö
authors.lastname: Tabak
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey.
authors.forename: Ada
authors.initials: A
authors.lastname: Salaj
authors.affiliation: Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Capa, 34390, Istanbul, Turkey.
authors.forename: Sercan
authors.initials: S
authors.lastname: Karabulut
authors.affiliation: Psychiatry Research, North Shore Long Island Jewish Health System, The Zucker Hillside Hospital, Glen Oaks, NY, USA.|Department of Psychiatry, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY, USA.|Department of Molecular Medicine, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, NY, USA.|The Feinstein Institute for Medical Research, Manhasset, NY, USA.|Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine