Patient attitudes to clozapine initiation

Clozapine is widely underused. No study has assessed views of patients suitable for, but not yet receiving, clozapine. We aimed to assess views of clozapine in patients eligible for clozapine but not yet prescribed it by conducting semistructured interviews with acutely unwell hospital in-patients. We interviewed 61 of 116 eligible patients and 50 (82%) answered all questions. At interview, 33 (54%) of 61 participants had heard of clozapine and 17 (30%) of 57 participants said they would take it if asked. Overall, 31 (57%) of 54 respondents said blood testing would not preclude them taking clozapine. The necessity for hospital admission was seen as the greatest barrier to receiving clozapine - 25 (49%) of 51 respondents stated this would be a reason for their refusing clozapine. Concerns about adverse effects of clozapine were considered sufficient to refuse clozapine in 23 (43.4%) of 53 respondents. Overall, 12 (24%) of 50 respondents felt that clozapine would be helpful to them. Patients' acceptance of clozapine is likely to be improved by offering the opportunity to start clozapine at home and by improved education about the therapeutic benefits of clozapine and the management of its adverse effects. Blood testing does not appear to be an important barrier to the initiation of clozapine.