Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized: A retrospective analysis of real-world practice

Background: Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. Methods: We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. Results: The physician adherence rate to ABP was 95%. Response and remission rates were 76.0% and 48.6% in the first adequate antipsychotic trial (Phase I, n=146), 62.5% and 25.0% in the second adequate antipsychotic trial (Phase II, n=32), and 16.7% and 0% in the third adequate antipsychotic trial (Phase III, n=6). Response and remission rates in the clozapine trial (n=9) increased to nearly the level of Phase I (66.7% and 44.4%). The treatment-resistance rate was 8.4% to 10.3%. Conclusions: These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.