title: Prescribing pattern of clozapine and other antipsychotics for patients with first-episode psychosis: a cross-sectional survey of early intervention teams.
abstract: OBJECTIVE
  To describe the pattern of antipsychotic drug prescribing in patients with first episode psychosis, with more emphasis in the use of clozapine in this group of patients.
  
  
  METHODS
  A cross-sectional survey involving six early intervention service (EIS) teams in the West Midlands was conducted. Data was extracted from case notes and electronic records by clinicians working in each participating team. The pattern of antipsychotic prescribing and the changes that took place after being accepted in EIS, including the use of clozapine, was established. Clinicians involved in the treatment of patients in each team rated the overall clinical response to treatment based on the presence or absence of positive psychotic symptoms.
  
  
  RESULTS
  431 patients with FEP were included in the final analysis. Low antipsychotic discontinuation rate was observed, with the majority (88.2%) still being prescribed antipsychotics. Most (77.3%) were prescribed second-generation antipsychotic drugs, with olanzapine (21.8%) and aripiprazole (19.7%) being the most frequently prescribed antipsychotics. There was low rate use of antipsychotic combinations (7.4%), high dose antipsychotic regime (3.9%), low depot antipsychotic prescribing (9.3%), and clozapine use was low (9.7%). On average, three antipsychotics were tried before clozapine was initiated and it took on average 19.5 months from being accepted into EIS to clozapine being initiated.
  
  
  CONCLUSIONS
  The majority of patients were prescribed antipsychotics within the guidelines. EIS was associated with an overall low antipsychotic discontinuation. There was also a short waiting time before clozapine was initiated following patients being accepted into EIS.
authors.affiliation: Consultant General Adult Psychiatrist (Rehabilitation), Partnerships in Care Ltd., Beverley House, 527-529 City Road, Birmingham, B617 8LL (Formerly Consultant EIS, Wolverhampton), UK.
authors.forename: Tongeji E
authors.initials: TE
authors.lastname: Tungaraza
authors.affiliation: Consultant General Adult Psychiatrist, MHHTT, Park House, North Manchester, Manchester Mental Health & Social Care Trust, UK.
authors.forename: Wakil
authors.initials: W
authors.lastname: Ahmed
authors.affiliation: Consultant in Child and Adolescent Psychiatry, Birmingham Children's Hospital, UK.
authors.forename: Chinonyelum
authors.initials: C
authors.lastname: Chira
authors.affiliation: Consultant Solihull Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, UK.
authors.forename: Erin
authors.initials: E
authors.lastname: Turner
authors.affiliation: Consultant General Adult Psychiatrist, Assertive Outreach Team, and Rehabilitation, Hereford, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Mayaki
authors.affiliation: Consultant Psychiatrist, C&W Partnership Trust. Ashton house, Leamington Spa, UK.
authors.forename: Harpal Singh
authors.initials: HS
authors.lastname: Nandhra
authors.affiliation: Consultant Psychiatrist, Dudley and Walsall Mental Health Partnership NHS Trust, Walsall Assertive Outreach Team and Walsall North Community Recovery Service, Dorothy Pattison Hospital, Alumwell Close, Walsall, West Midlands, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Edwards
authors.affiliation: Clinical Senior Lecturer, Research Institute for Primary Care & Health Sciences, Keele University, UK Honorary Consultant Psychiatrist, South Staffordshire and Shropshire NHS Foundation Trust, UK.
authors.forename: Saeed
authors.initials: S
authors.lastname: Farooq
keywords: antipsychotics; clozapine; cross-sectional survey; first-episode psychosis