{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:09:11Z","timestamp":1788865751533,"version":"build-2803163510"},"reference-count":40,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120997_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clozapine is the only antipsychotic with demonstrated efficacy in treatment-resistant schizophrenia, but remains underutilised worldwide, with limited data from the Middle East and North Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120997_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We examined clozapine initiation, delays and outcomes in a large United Arab Emirates (UAE) cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120997_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients prescribed antipsychotics at a tertiary psychiatric hospital in the UAE (2018\u20132025). Treatment resistance was defined as two or more distinct sequential adequate antipsychotic trials, each for at least 6 weeks and at a drug-specific therapeutic dose (defined daily dose method). Outcomes were clozapine initiation, time to initiation, guideline concordance (within 3 months) and hospital admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120997_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 6256 patients with schizophrenia spectrum diagnoses prescribed antipsychotics, 1738 (27.8%) met treatment-resistance criteria. Clozapine was initiated in 129 (7.4%; 95% CI 6.3\u20138.8%), comparably between expatriates and nationals (7.7\n                      <jats:italic>v<\/jats:italic>\n                      . 7.1%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.72). Among 76 delayed initiators, median delay was 13.2 months (interquartile range 2.2\u201332.5) and 26.3% were guideline-concordant. The number of adequate trials most strongly predicted initiation (adjusted odds ratio 1.98, 95% CI 1.70\u20132.30;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Delayed initiation was associated with higher hospital admission rates (adjusted incidence rate ratios 2.5\u20132.6 for delays up to 24 months;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05), although an exploratory propensity-weighted analysis was underpowered (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = \u22122.57;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.12).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120997_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clozapine remains underutilised in this setting, with fewer than 1 in 12 treatment-resistant patients receiving it and only a quarter of delayed initiators achieving guideline-concordant timing. These findings highlight an evidence-to-practice gap and support strategies for earlier clozapine access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12099","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:29:51Z","timestamp":1788863391000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Time to clozapine initiation in treatment-resistant schizophrenia in the United Arab Emirates: retrospective cohort study with international benchmarking"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1190-7613","authenticated-orcid":false,"given":"Syed Ali","family":"Bokhari","sequence":"first","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7012-176X","authenticated-orcid":false,"given":"Mohamed Abdalhameed Osman","family":"Alnor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Khartoum"},{"name":"Al Ain Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6467-8150","authenticated-orcid":false,"given":"Syed Fahad","family":"Javaid","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01km6p862","id-type":"ROR","asserted-by":"publisher"}],"name":"United Arab Emirates University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhanad","family":"Elnoor","sequence":"additional","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"S2056472426120997_ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-21607-9"},{"key":"S2056472426120997_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(25)00001-X"},{"key":"S2056472426120997_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2018.12.011"},{"key":"S2056472426120997_ref9","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.105833"},{"key":"S2056472426120997_ref13","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-05176-y"},{"key":"S2056472426120997_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2018.02.054"},{"key":"S2056472426120997_ref36","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201700162"},{"key":"S2056472426120997_ref34","doi-asserted-by":"publisher","DOI":"10.1111\/eip.13578"},{"key":"S2056472426120997_ref15","doi-asserted-by":"publisher","DOI":"10.1192\/bjb.2018.67"},{"key":"S2056472426120997_ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.4320"},{"key":"S2056472426120997_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2012.03.003"},{"key":"S2056472426120997_ref33","doi-asserted-by":"publisher","DOI":"10.1177\/02698811221104060"},{"key":"S2056472426120997_ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-019-0345-9"},{"key":"S2056472426120997_ref2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.61"},{"key":"S2056472426120997_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2025.104698"},{"key":"S2056472426120997_ref24","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-021-01613-2"},{"key":"S2056472426120997_ref3","unstructured":"3 National Institute for Health and Care Excellence. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e232"}}