Citation

Sharma S, Kopelovich SL, Janjua AU, Pritchett C, Broussard B, Dhir M, Wilson JG, Goldsmith DR, Cotes RO. Schizophrenia Bulletin Open 2021; 2(1).

Copyright

(Copyright © 2021, Oxford University Press)

DOI

10.1093/schizbullopen/sgab043

PMID

unavailable

Abstract

Despite its unique efficacy, clozapine remains underutilized in the United States. Perceptions about clozapine and barriers to its use have been examined among prescribers, but insufficiently studied among consumers. We surveyed 211 antipsychotic consumers (86 on clozapine and 125 on other antipsychotics) on their medication-related perspectives in a public hospital system in Atlanta, Georgia, USA. In contrast to their previous regimen, 72% of clozapine consumers reported they were more satisfied with clozapine. When compared with consumers taking other antipsychotics, clozapine consumers reported more side effects but did not differ on other measures of satisfaction or efficacy. We found Caucasians to be overrepresented among clozapine, as compared to other antipsychotic consumers. Side effects most strongly associated with poor safety ratings were sedation, limb jerking, and dizziness when standing. However, clozapine was only rated less safe by consumers who experienced more than one of these side effects. We used an unsupervised clustering approach to identify three major groups of clozapine consumers. Cluster A (19%) had the lowest safety ratings, aversion to blood work, and a high rate of side effects that associate with lower safety ratings. Cluster B (25%) experienced more hospitalizations and reported satisfaction with clozapine that correlated with efficacy ratings, irrespective of safety ratings. Cluster C (56%) experienced fewer hospitalizations, fewer previous drug trials, greater educational attainment, lower rates of smoking, and rated clozapine more highly. This work identifies common side effects that influence the subjective safety of clozapine and suggests that attitudes toward clozapine depend on context-specific factors. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.

Language: en

Keywords

adult; human; female; male; cannabis; suicide attempt; hospitalization; clozapine; attitudes; African American; Asian; major clinical study; vomiting; controlled study; neuroleptic agent; sexual dysfunction; smoking; sedation; xerostomia; priority journal; quetiapine; constipation; haloperidol; Hispanic; drug safety; seizure; drug efficacy; olanzapine; risperidone; nausea; hypersalivation; hypotension; patient satisfaction; chlorpromazine; side effect; diabetes mellitus; ziprasidone; Caucasian; public hospital; cluster analysis; muscle rigidity; educational status; dizziness; aripiprazole; unspecified side effect; fluphenazine; Article; blood cell count; standing; paliperidone; nocturnal enuresis; limb disease; lurasidone; body weight gain; schizophrenia spectrum disorders; shared decision making; customer satisfaction; Georgia (U.S.)