Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care
Abstract
OBJECTIVE: Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China. METHOD: A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection. RESULTS: The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics. CONCLUSIONS: Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients on clozapine are more likely than those on other agents to have better insight.
“Hou et al 174 reported that patients on clozapine were more likely than their peers on other agents to have better insight.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [174]
Cited by
Sorted by citations
Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Insight and medication adherence in schizophrenia: An analysis of the CATIE trial
Kim, J., Ozzoude, M., Nakajima, S., Shah, P., Caravaggio, F., Iwata, Y., Luca, V. D., Graff‐Guerrero, A., & Gerretsen, P. (2019) · Neuropharmacology · doi:10.1016/j.neuropharm.2019.05.011 · Cited by 138 · see citing works
Sampogna, G., Vincenzo, M. D., Giuliani, L., Menculini, G., Mancuso, E., Arsenio, E., Cipolla, S., Rocca, B. D., Martiadis, V., Signorelli, M. S., et al. (2023) · Brain Sciences · doi:10.3390/brainsci13111577 · Cited by 66 · see citing works
“Only the study by Fervaha et al. [105] found a modest effect of olanzapine, perphenazine, and quetiapine on quality of life and seven other studies [82,91,93,94,100,106,107] found no effect of oral antipsychotics on quality of life.”
BackgroundLysaker, P. H., Weiden, P. J., Sun, X., O’Sullivan, A. K., & McEvoy, J. P. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04190-w · Cited by 36 · see citing works
“Clozapine and second-generation antipsychotics have been associated with improvements in insight in schizophrenia [20, 56].”
BackgroundYuan, X., Wang, S., Shi, Y., Yang, Y., Zhang, Y., Xia, L., Zhang, K., & Liu, H. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06067-y · Cited by 31 · see citing works
“Thus far, clozapine has remained the first choice for patients with schizophrenia in some parts of China throughout the 1990s (Xiang et al. 2007; Wang and Li 2012; Hou et al. 2015).”
BackgroundQuality of life in Chinese patients with schizophrenia treated in primary care
Li, Y., Hou, C., Ma, X.-R., Zhong, B., Zang, Y., Jia, F., Lin, Y.-Q., Lai, K. Y. C., Chiu, H. F. K., Ungvari, G. S., et al. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.04.049 · Cited by 27 · see citing works
“…and Treatment Attitude Questionnaire; MADRS=Montgomery-Åsberg Depression Rating Scale; SAS=Simpson and Angus Scale of Extrapyramidal Symptoms; SGA=second-generation antipsychotics. a Part of the clinical characteristics were reported elsewhere (Hou et al., 2015, 2016b, 2016c; Li et al., 2016).”
InfluentialSelf-citationHou, C., Wang, S., Wang, F. “., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2217-1 · Cited by 16 · see citing works
Self-citationYang, C.-Y., Zhou, R., Liu, Y., Wang, S., Hou, C., & Jia, F. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1522975 · Cited by 6 · see citing works
“Doses of antipsychotic drugs were converted into the prescribed daily dose/de fi ned daily dose ratio (PDD/DDD ratio) (56).”
Self-citationStabell, L. A., Johnsen, E., Kroken, R. A., Løberg, E., Blindheim, A. A., Joa, I., Reitan, S. K., Rettenbacher, M. A., Munk‐Jørgensen, P., & Gjestad, R. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04981-9 · Cited by 5 · see citing works
Wang, F., Huang, Z., Migliorini, C., Wang, S., Chen, Z.-L., Wang, Q., He, X., Harvey, C. A., & Hou, C. (2022) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2022.103434 · Cited by 1 · see citing works
Self-citationCaracterísticas del insight en la esquizofrenia. Una revisión bibliográfica
Sotelo, D., Grasso, V., & Meloni, G. (2021) · Vertex Revista Argentina de Psiquiatría · doi:10.53680/vertex.v32i151.27
No QOL impact of clozapine in China
(2015) · PharmacoEconomics & Outcomes News · doi:10.1007/s40274-015-2405-2
- Authors
- Hou, C.-L., Cai, M.-Y., Ma, X.-R., Zang, Y., Jia, F.-J., Lin, Y.-Q., Chiu, H., Ungvari, G., Ng, C., Zhong, B.-L., Cao, X.-L., Li, Y., Shinfuku, N., & Xiang, Y.-T.
- Affiliations
- Guangdong General Hospital (CN)
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
- Shenzhen KangNing Hospital (CN)
- Chinese University of Hong Kong (HK)
- The University of Western Australia (AU)
- The University of Melbourne (AU)
- Kobe University (JP)
- University of Macau (MO)
- Venue
- Pharmacopsychiatry
- Publisher
- Georg Thieme Verlag KG
- Published
- 2015-08-05
- Volume
- 48
- Issue
- 06
- Pages
- 200-204
- ISSN
- 0176-3679 (ISSN-L)
- 1439-0795
- OpenAlex
- W1057378807
- Cited by
- 13
- References
- 0
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2015: 1
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacopsychiatry (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- clozapine, schizophrenia, primary care, quality of life, insight, extrapyramidal symptoms, antipsychotic prescribing, typical antipsychotics, maintenance therapy, age of onset, hospitalization, adverse drug reactions, China
- MeSH terms
- Clozapine, Drug Utilization, Female, Humans, Male, Middle Aged, Primary Health Care, Quality of Life, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Asian People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
