Hospital days in clozapine-treated patients

Abstract

Objective: To examine inpatient hospital days used by a group of patients with treatment-resistant schizophrenia for 3 years before and 3 years after clozapine initiation.

Method: A retrospective chart review of 26 consecutive admissions to an outpatient clozapine clinic was conducted for a 6-year period. The total number of hospital days was recorded.

Results: Patients separated into 3 groups: those who used clozapine for 3 uninterrupted years (N = 11, 42.3%), those who interrupted but resumed clozapine and continued on to 3 years (N = 4, 15.4%), and those who abandoned clozapine treatment (N = 11, 42.3%). Only the group that was continuously on clozapine showed a decline in percentage of inpatient days during the 3-year follow-up period. Three of the 11 patients who discontinued clozapine died during the posttreatment period: 2 suicides and 1 "death by misadventure."

Conclusions: Continuous clozapine treatment significantly reduces days in hospital; this reduction was sustained throughout 3 years' follow-up. While the sample size is small, all patients were tracked over a 6-year period, and both drug continuers and dropouts were followed. The reduction in inpatient days may be lost if patients stop and then restart clozapine. For patients who do not respond to or abandon trials of clozapine, there is an urgent need to develop more effective treatment strategies.