{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:58:29Z","timestamp":1791986309491,"version":"4.4.0"},"reference-count":86,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Human Psychopharmacology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    This review aims to examine the appropriateness of the term \u2018clozaphobia\u2019 to characterise the obstacles contributing to the underprescription of clozapine (CLZ). English\u2010language, peer\u2010reviewed studies addressing clinicians', patients' and\/or carers' attitudes toward CLZ were considered eligible for full\u2010text review. In May 2025, a search was conducted using the keywords\n                    <jats:italic>clozapine, clozaphobia<\/jats:italic>\n                    ,\n                    <jats:italic>fear*<\/jats:italic>\n                    ,\n                    <jats:italic>underus*<\/jats:italic>\n                    ,\n                    <jats:italic>underprescri*<\/jats:italic>\n                    ,\n                    <jats:italic>underutiliz*<\/jats:italic>\n                    , and\n                    <jats:italic>barrier*<\/jats:italic>\n                    , restricted to titles and abstracts on PubMed, Web of Science, Scopus, and Cochrane. A total of 362 records were retrieved, and 30 records were identified through backward citation searching. After screening, 53 studies were eligible for review. This review identified several barriers to CLZ use, which were grouped into three broad domains: clinician\u2010related, medication\u2010 and patient\u2010related, and administrative\u2010related barriers. Key barriers included difficulties in recognising Treatment\u2010Resistant Schizophrenia (TRS) and identifying candidates for CLZ, lack of training and confidence, negative attitudes toward CLZ, variability in treatment pathways, concerns about CLZ's adverse effects, and challenges in convincing carers of the need for CLZ, insufficient resources, unclear professional roles, and fragmentation of services. The vast majority of identified barriers stem from misconceptions or negative attitudes toward CLZ, which unjustifiably limit patient access to this effective treatment, and can be addressed through the implementation of existing facilitating strategies. In such contexts, the term clozaphobia seems appropriate and its use may help to raise awareness and promote critical reflexion on this subject. With the end of the clozapine risk evaluation and mitigation strategy, it is now time to push society to start producing higher dose pills and a long\u2010acting injectable version of clozapine.\n                  <\/jats:p>","DOI":"10.1002\/hup.70050","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:41:16Z","timestamp":1778823676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Underprescription of Clozapine: A Narrative Review Regarding \u2018Clozaphobia\u2019"],"prefix":"10.1002","volume":"41","author":[{"given":"Rafael","family":"Brito Castro","sequence":"first","affiliation":[{"name":"Cl\u00ednica Universit\u00e1ria de Psiquiatria e Psicologia M\u00e9dica (CUPPM) Faculdade de Medicina Universidade de Lisboa (FMUL) Centro Acad\u00e9mico de Medicina de Lisboa (CAML)  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3950-5113","authenticated-orcid":false,"given":"Joaquim J.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Farmacologia Cl\u00ednica e Terap\u00eautica (LFCT) Faculdade de Medicina, Universidade de Lisboa (FMUL), Centro Acad\u00e9mico de Medicina de Lisboa (CAML)  Lisboa Portugal"},{"name":"Campus Neurol\u00f3gico S\u00e9nior (CNS)  Torres Vedras Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0662-5178","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Gama\u2010Marques","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Universit\u00e1ria de Psiquiatria e Psicologia M\u00e9dica (CUPPM) Faculdade de Medicina Universidade de Lisboa (FMUL) Centro Acad\u00e9mico de Medicina de Lisboa (CAML)  Lisboa Portugal"},{"name":"Consulta de Esquizofrenia Resistente (CER) Hospital de J\u00falio de Matos (HJM), Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9 (ULSSJ), Centro Cl\u00ednico Acad\u00e9mico de Lisboa (CCAL)  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2024.04.012"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.25f16038"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291701003749"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/20451253211000865"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2020.100"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2014.11.022"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2024.1385398"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.5455\/bcp.20141223052008"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/10398562241258764"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1192\/pb.29.10.377"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10597\u2010021\u201000847\u20100"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7002.451"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.03.029"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12233"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13141668"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S566527"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.n87507"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2018.67"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867411433210"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.20344\/amp.16805"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.20344\/amp.18209"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.08.002"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/YPG.0000000000000383"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.b.33062"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12193"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.70542\/rcj\u2010japh\u2010art\u2010tk8qqh"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1017\/ipm.2024.35"},{"key":"e_1_2_13_29_1","unstructured":"Grau\u2010L\u00f3pez L. 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