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A study of clozapine and long-term hospitalisation rates

Senior House Officer, Ablett Psychiatric Unit, Glan Clwyd Hospital and Department of Psychological Medicine, University of Wales College of Medicine (UWCM) Academic Unit

David B. Menkes, FRANZCP

Professor of Psychological Medicine, Department of Psychological Medicine, UWCM Academic Unit, Wrecsam

Thomas R. Trevelyan, MRCPsych

Consultant Psychiatrist

^*Colin P. Lanceley, MRCPsych

Consultant Psychiatrist, Ablett Psychiatric Unit, Glan Clwyd Hospital, Bodelwyddan, Denbighshire LL18 5UJ (tel: 01745 585484; fax: 01745 534405)

Declaration of interest

None.

AIMS AND METHOD

The aim of the study was to investigate the use of clozapine in treatment-resistant schizophrenia and its impact on hospitalisation rates when prescribed in accordance with National Institute for Clinical Excellence (NICE) guidelines. Case records were examined of patients admitted to the psychiatric unit of Glan Clwyd Hospital between 1996 and 2001.

RESULTS

Of 59 patients identified as having treatment-resistant schizophrenia, 83% had been considered for clozapine, 48% were taking clozapine, 20% had refused the drug and 15% had stopped taking it because of side-effects. The mean annual hospitalisation rate for patients receiving clozapine for a minimum of 3 years was 13.5 days, markedly lower than those not receiving this drug (34.0 days, P=0.03). Older patients were less likely to have been offered clozapine (P=0.006).

CLINICAL IMPLICATIONS

This study supports the NICE guidelines recommending clozapine for patients with treatment-resistant disease. Clozapine is offered less often to older patients; factors influencing this require investigation.

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