A Clozaril Clinic Model for Successful Treatment of Serious Mental Illness

Background: Clozaril (generic form Clozapine) is an atypical antipsychotic medication that is appropriate for use with a subset of individuals with psychotic disorders who have not benefited from conventional antipsychotic medications. This presentation provides an overview of an agency based integrated outpatient model for treating clients with Clozaril and reports on 12 years of outcome findings (n=114). The “Clozaril Clinic” model is built on an interdisciplinary team approach that emphasizes the importance of regular peer interaction, at-site provision of ancillary services, and full coordination by the team of all other treatment, rehabilitation and support services, including specialized case management. The purpose of this study was to examine the effectiveness of the Clozaril Clinic Model for reducing psychiatric symptoms, decreasing the number of psychiatric admissions and days spent inpatient, and improving overall aspects of wellbeing including employment, social relationships, and global functioning.

Method: Since its inception in 1992, 114 consumers, ages 16 to 69 that had not previously been prescribed Clozaril participated in the Clozaril Clinic. Of the 114 consumers originally accepted into the clinic, 67 individuals continue to receive services and serve as the sample for this study. Their diagnostic profiles include 78% having Schizophrenia and 22% Schizoaffective Disorder. For analysis they were grouped into three sample groups as follows: Sample Group A (receiving services for less than a year), Sample Group B (1-5 years in treatment), and Sample Group C (more than 5 years). Primary indicators related to number of inpatient psychiatric admissions/days and suicide attempts 2-years prior to their enrollment in the Clozaril Clinic were compared to post-enrollment numbers. Scores on the Brief Psychiatric Rating Scale and Global Assessment of Functioning Scale at time of enrollment to the clinic were compared to current scale scores. Data were collected using these indicators and analyzed.

Results: Results indicate that the Clozaril Clinic Model which incorporates Clozaril, case management and other supports appears to facilitate an unusually high level of recovery. Individuals provided treatment services through this model dramatically decreased their need for inpatient psychiatric hospitalization as well as had reduced suicidal impulses. Individuals reached a higher level of mental clarity, devoid of psychotic symptoms such as hallucinations or paranoia, dramatic gestures and lethal attempts were greatly reduced. Measured by the BPRS and the GAF scales, overall functioning also improved through the use of Clozaril supported by the clinic model when other anti-psychotic medications had previously failed to produce such improvements.

Conclusion: Results indicate that Clozaril delivered within this model promotes an unusually high level of recovery from serious mental illness, including a dramatic level of relief from psychotic symptoms, shielding of suicidal impulses, and reducing outpatient hospitalizations. Outcomes also included improvement in overall wellbeing as individuals made progress in the domains of employment and personal relationships. The implications of this study is that Clozaril, when provided for individuals in this type of model, can greatly improve the life of individuals with serious and persistent mental illness who have not yet responded to previous treatment.