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Can J Psychiatry. 2017 Feb;62(2):109-114. doi: 10.1177/0706743716651049. Epub 2016 Jul 9.

What Is the Place of Clozapine in the Treatment of Early Psychosis in Canada?

Author information

1
1 Department of Psychiatry, University of British Columbia, Victoria, British Columbia.
2
2 Department of Psychiatry, McGill University, Montréal, Québec.
3
3 Prevention and Early Intervention Program for the Psychoses, Douglas Mental Health University Institute, Montréal, Québec.
4
4 Département de Psychiatrie et Neurosciences, Faculté de Médecine de l'Université Laval, Québec, Québec.
5
5 Clinique Notre-Dame des Victoires, Centre intégré universitaire de la Capitale Nationale, Québec, Québec.
6
6 Psychiatry, Western University, London, Ontario.
7
7 Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario.
8
8 Dalhousie University, Halifax, Nova Scotia.
9
9 Nova Scotia Early Psychosis Program, Halifax, Nova Scotia.
10
10 Canadian Consortium for Early Intervention in Psychosis, Hamilton, Ontario.
11
11 Complex Mental Illness Program/Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario.
12
12 Department of Psychiatry, University of Toronto, Toronto, Ontario.

Abstract

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.

KEYWORDS:

clozapine; first episode; treatment resistance psychosis

PMID:
27310245
PMCID:
PMC5298522
DOI:
10.1177/0706743716651049
[Indexed for MEDLINE]
Free PMC Article

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