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Psychiatrists’ views on clozapine prescribing in Ireland

Published online by Cambridge University Press:  02 October 2024

A. Grant ,
R. McManus ,
H. Belay ,
M. Mahon ,
F. Murad ,
B. O’ Donoghue  and
J. Lally Open the ORCID record for J. Lally [Opens in a new window]
A. Grant
Affiliation:
National Forensic Mental Health Service Facility, Dublin, Ireland Department of Psychiatry, Connolly Hospital, Dublin, Ireland
R. McManus
Affiliation:
Department of Psychiatry, St Vincent’s Hospital Fairview, Dublin, Ireland Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
H. Belay
Affiliation:
Department of Psychiatry, Connolly Hospital, Dublin, Ireland
M. Mahon
Affiliation:
Department of Psychiatry, Connolly Hospital, Dublin, Ireland
F. Murad
Affiliation:
Department of Psychiatry, St Vincent’s Hospital Fairview, Dublin, Ireland
B. O’ Donoghue
Affiliation:
Department of Psychiatry, St Vincent’s University Hospital, Dublin, Ireland Department of Psychiatry, University College Dublin, Dublin, Ireland
J. Lally*
Affiliation:
Department of Psychiatry, St Vincent’s Hospital Fairview, Dublin, Ireland Department of Psychiatry, University College Dublin, Dublin, Ireland Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
*
Corresponding author: J. Lally; Email: [email protected]
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Abstract

Introduction:

Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study’s aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use.

Methods:

A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland.

Results:

Twenty-eight percent (n = 77) completed the survey, with 55% of respondents practicing for 15 or more years. Clinicians expressed confidence in managing clozapine treatment and side effects and were well aware of clozapine’s clinical effectiveness and guideline-based use. A majority indicated insufficient experience managing rechallenge and half expressed insufficient experience managing adverse events. Perceived patient factors were highlighted as barriers with 69% of respondents reporting patients’ concern about effectiveness and 50% regarding tolerability. Sixty-four percent (n = 40) indicated that a specialised/tertiary clozapine service would facilitate initiation, with 57% (n = 36) reporting less frequent blood monitoring would aid clozapine prescribing. A majority identified that access to dedicated staff (81%, n = 51) and dedicated day hospital services (84%, n = 53) would facilitate community initiation.

Conclusion:

Consultants are familiar with clozapine use and related guidelines. Dedicated staff and facilities for clozapine use is one identified structural change to enhance clozapine prescribing in Ireland. Tertiary service or clinical advice service would assist in clozapine rechallenge cases or in managing significant adverse events. More structured patient education regarding clozapine effectiveness and professional development programmes focused on managing side effects and rechallenge may promote clozapine use.

Keywords

Treatment-resistant schizophreniapsychosisantipsychoticsclozapineattitude
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 41 , Issue 4 , December 2024 , pp. 439 - 445
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of College of Psychiatrists of Ireland

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