How many clients with refractory psychosis are eligible for both cognitive-behaviour therapy and clozapine? A chart-review study

Abstract

Substantial evidence supports the use of either clozapine or cognitive-behaviour therapy (CBT) for refractory symptoms of psychosis, and are recommended in many national guidelines. However, the two treatments have not been directly compared in a head-to-head trial. The aim of this study is to estimate the proportion of clients with refractory symptoms of psychosis who might benefit from either treatment. We reviewed the charts of 137 clients, consecutively referred to a speciality clinic for refractory psychosis, against inclusion and exclusion criteria for both clozapine and CBT. The results indicate that approximately one-third of patients referred for either CBT or clozapine would simultaneously meet eligibility criteria for both treatments, and would thus be eligible for randomization. If these results are validated in a prospective study, a controlled trial comparing CBT and clozapine for refractory symptoms of psychosis is likely feasible.