Clozapine use and outcomes among patients with treatment resistant schizophrenia

Objective : The phenomenology of patients with schizophrenia is similar world-wide, regardless of culture. However, the prognosis is variable both internationally and within national groups of patients. Furthermore, despite advances in pharmacological treatment, a significant proportion of patients with schizophrenia continue to show residual symptoms and disabilities due to poor response to antipsychotic medication. This study retrospectively assessed differences in outcome by gender, ethnicity and age among a group of treatment-resistant patients with schizophrenia. Method : Patients in the catchment (350 000 people) of a single New Zealand public mental health provider (Waikato) formed the study group. Information concerning demographic profiles, Health of the Nation Outcome Scales (HoNOS) ratings and details of Clozapine usage were extracted from clinical records and the data base. Results : Gender, ethnicity and age did not emerge as significantly associated with any of the outcome variables except for the 30-40 year olds having more improvement on overactivity/aggression ratings than younger or older patients. Conclusions : Despite these negative results in the New Zealand context, there remain many unanswered questions about the higher rate of service use by Maori. Replication of this study on a larger cohort of patients may be indicated before discarding the idea of potential links between ethnicity, treatment choice and outcomes.