{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T16:54:54Z","timestamp":1778864094821,"version":"3.51.4"},"reference-count":34,"publisher":"American Psychiatric Association Publishing","issue":"3","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psych Res and Clin Practice"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Hypothesis<\/jats:title>\n                    <jats:p>Clozapine is an effective yet underutilized treatment for treatment\u2010resistant schizophrenia spectrum disorders. This study aimed to identify factors affecting clozapine prescribing patterns among patients with treatment\u2010resistant schizophrenia and schizoaffective disorder at an academic medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This retrospective combined cohort and case\u2010control study examined demographic, socioeconomic, medical and psychiatric characteristics to determine predictors of clozapine initiation. Eligible patients had a diagnosis of schizophrenia or schizoaffective disorder with at least two prior antipsychotic trials and were admitted to a University of Utah inpatient psychiatric facility (1\/2014\u20133\/2021). Patients who did and did not receive clozapine during the index hospitalization were compared in cohort and case\u2010control study arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Results<\/jats:title>\n                    <jats:p>\n                      Twelve percent (59\/477) of the cohort received clozapine during the index admission. Among the cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0477), Black patients were twice as likely to receive clozapine than White and Hispanic patients (OR 2.18, 95% CI 1.20\u20133.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008). In the case\u2010control analysis, patients with a greater number of previous psychiatric admissions (OR 1.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.079) and antipsychotic trials (OR 1.40,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.038) had greater odds of receiving clozapine. Homelessness was identified as a predictor against clozapine use (OR 2.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to identify homelessness as a predictor against clozapine use, which raises important clinical and ethical considerations. Our findings also add to the literature on clozapine prescribing discrepancies among ethnic\u2010minority patients. Overall, clozapine remains underutilized as the gold\u2010standard treatment for treatment\u2010resistant schizophrenia\u2010spectrum disorders, reinforcing a need to improve evidence\u2010based prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1176\/appi.prcp.20240056","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T12:54:40Z","timestamp":1719579280000},"page":"104-111","source":"Crossref","is-referenced-by-count":3,"title":["Medical, Psychiatric, and Sociodemographic Predictors of Clozapine Initiation at an Academic Medical Center"],"prefix":"10.1176","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-5904","authenticated-orcid":false,"given":"Kathleen","family":"Shangraw","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Schmutz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Dowdle","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Campbell University of Osteopathic Medicine  Lillington North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Kelley","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caleb","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merrick","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Sutton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Kious","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Utah  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"230","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0920\u20109964(00)00108\u20100"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.105833"},{"key":"e_1_2_6_4_1","unstructured":"Overview | Psychosis and schizophrenia in adults | Quality standards | NICE. [cited 2023 Oct 27].https:\/\/www.nice.org.uk\/guidance\/qs80"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.4088\/jcp.v68n1115"},{"issue":"2","key":"e_1_2_6_6_1","first-page":"1","article-title":"Practice guideline for the treatment of patients with schizophrenia, second edition","volume":"161","author":"Lehman AF","year":"2004","journal-title":"Am J Psychiatr"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800330013001"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.58.10.965"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.4.600"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006633.pub2"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20632"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.56.6.565"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2018.05.046"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2018.67"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000027694"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.3371\/CSRP.6.3.5"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201300180"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.202000932"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.03.010"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12683"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.3371\/CSRP.KEBE.070415"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201300001"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.4.567"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/104012371502700403"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.09.033"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2020.07.023"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291722001878"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbl068"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127\u2010022\u201002257\u20103"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11126\u2010017\u20109521\u2010z"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1017\/S146114571100201X"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/bs.apha.2017.09.009"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/02698811221142575"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e318267b3cd"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2017.01.064"}],"container-title":["Psychiatric Research and Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1176\/appi.prcp.20240056","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T15:47:37Z","timestamp":1766418457000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1176\/appi.prcp.20240056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,28]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1176\/appi.prcp.20240056"],"URL":"https:\/\/doi.org\/10.1176\/appi.prcp.20240056","archive":["Portico"],"relation":{},"ISSN":["2575-5609","2575-5609"],"issn-type":[{"value":"2575-5609","type":"print"},{"value":"2575-5609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,28]]}}}