An evaluation of subjective experiences, effects and overall satisfaction with clozapine treatment in a UK forensic service

Inti Qurashi; Paul Stephenson; Simon Chu; Chris Duffy; Nusrat Husain; Imran Chaudhry

doi:10.1177/2045125315581996

An evaluation of subjective experiences, effects and overall satisfaction with clozapine treatment in a UK forensic service

Ther Adv Psychopharmacol. 2015 Jun;5(3):146-50. doi: 10.1177/2045125315581996.

Authors

Inti Qurashi¹, Paul Stephenson², Simon Chu¹, Chris Duffy¹, Nusrat Husain³, Imran Chaudhry⁴

Affiliations

¹ Ashworth Hospital, Mersey Care NHS Trust, Liverpool, UK.
² Ashworth Hospital, Mersey Care NHS Trust, Parkbourn, Liverpool, Merseyside L31 1HW, UK.
³ Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK.
⁴ Adult Psychiatry, University of Manchester, Manchester, UK.

Abstract

Objectives: Patients prescribed clozapine were surveyed to assess (a) the effects, both positive and adverse, and overall satisfaction with clozapine in comparison to previously prescribed antipsychotics and (b) the relative significance of effects experienced, both positive and adverse, in terms of impact on subjective well-being.

Methods: A total of 56 male patients prescribed clozapine at a forensic psychiatric hospital were surveyed using a 27-item questionnaire. All patients had been prescribed clozapine for a minimum of 3 months. Respondents were asked to rate effects and satisfaction with clozapine treatment in comparison with previously prescribed antipsychotic medication on a five-point scale. Respondents were also asked to rate effects experienced with clozapine treatment in terms of impact on subjective well-being on a five-point scale.

Results: A total of 89% of respondents reported greater satisfaction with clozapine than with previously prescribed antipsychotic medication. A majority of patients reported positive effects in terms of an improvement in their quality of life (68%) and social abilities (52%) with clozapine in comparison with previously prescribed antipsychotics. Nocturnal hypersalivation (84%) and weight gain (57%) were the most common adverse effects. Hedonic responses were assessed for each effect in order to determine the associated subjective experiences. The most positive hedonic responses were for quality of life, mood and alertness. In terms of adverse impact on subjective well-being, nocturnal hypersalivation ranked highest.

Conclusions: Patients in a UK forensic sample are largely satisfied with clozapine treatment. The subjective effects of clozapine treatment should be taken into account by clinicians when assessing response. This may provide an opportunity to highlight the positive changes and prioritize management of the most undesirable adverse effects, which is likely to promote compliance and improve longer term treatment outcomes.

Keywords: clozapine; forensic; side effects; subjective experience.