Original ContributionsA Chart Audit Study of Clozapine Utilization in Early PsychosisLeclerc, Louis-David MD∗; Demers, Marie-France BPharm, MSc, BCPP†,‡; Bardell, Andrea MD, MSc, FRCPC§,∥; Bilodeau, Isabelle PharmD, MSc†,‡; Williams, Richard MPhil, FRCPC§,¶; Tibbo, Phil MD, FRCRC#,∗∗; Roy, Marc-André MD, MSC, FRCP∗,‡Author Information From the ∗Département de Psychiatrie et Neurosciences, Faculté de médecine, Université Laval, Québec †Faculté de pharmacie, Université Laval, Québec ‡Clinique Notre-Dame des Victoires, Institut universitaire en Santé mentale, Centre intégré universitaire de soins et services sociaux de la Capitale Nationale, Québec §Department of Psychiatry, University of British Columbia, Victoria, British Columbia ∥The Ottawa Hospital, Ottawa, Ontario ¶Victoria Early Psychosis Intervention Program, Victoria, British Columbia #Dalhousie University, Halifax, Nova Scotia ∗∗Nova Scotia Early Psychosis Program, Halifax, Nova Scotia, Canada. Received November 3, 2020; accepted after revision January 21, 2021. Reprints: Marc-André Roy, MD, MSC, FRCP, Clinique Notre-Dame des Victoires, 2525, Chemin de la Canardière, Entrée no. A-1-2, Québec, Canada, Canada G1J 2G3 (e-mail: [email protected]). Journal of Clinical Psychopharmacology: 5/6 2021 - Volume 41 - Issue 3 - p 275-280 doi: 10.1097/JCP.0000000000001384 Buy Metrics Abstract Purpose This study aimed to document the treatment trajectories and clozapine use in first-episode psychosis patients and to document the underlying reasons for using or not using clozapine in patients not achieving psychosis remission. Methods We conducted a retrospective chart audit of patients aged 18 to 30 years having DSM-5 diagnoses of schizophrenia spectrum psychotic disorders treated in 3 Canadian early intervention programs for psychosis. The severity of the patient's illness (using the Clinical Global Impression Severity [CGI-S] scale) and remission of psychosis were rated before and after each antipsychotic trial. Results One hundred and forty-seven patients were included in the study. There were 19.7% patients exposed to clozapine after an average of 2.4 antipsychotic trials and a mean delay of 470.8 days. There were 75.9% patients who improved their CGI-S score (mean improvement, 2.5) after the clozapine trial and 62.1% achieved a CGI-S score ≤3. Full remission of psychosis on clozapine was achieved in 69.0% of the patients. Clozapine was successfully used for some patients with a nonadherent profile in our sample (eg, personality disorder, substance use disorder). Although the mean duration of clozapine trials during the observation period was 688.6 days, no patient discontinued clozapine because of adherence issues. Conclusions Clozapine use in these early intervention programs were at a rate consistent to what is expected from the literature and allowed a majority of patients to achieve remission of psychosis and to experience a robust improvement of severity of illness. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.