Adults using clozapine have lower relapse rate, more adverse events
Bibliographic record
Abstract
Clozapine is considered first-line treatment for treatment-resistant psychoses, although evidence supporting its use in children and youths is more limited. Real-world data regarding the risks and benefits of clozapine for both adults and children can add important information to the evidence base. Investigators conducted a cohort study to examine the effects of clozapine on relapse rates and adverse events in adults and children. The investigators used data from the Canadian Institute of Health Information to identify patients in western Canada who were diagnosed with psychosis at the time of an initial hospital visit, as well as diagnoses of common childhood comorbid disorders such as attention-deficit hyperactivity disorder and autism. These individuals were followed for up to 10 years during the period from 2008–2018. The primary outcome was relapse, defined as a mental health visit or hospitalization after discharge from the initial visit. The main predictor was medication status, encompassing clozapine and other antipsychotics as well as other psychotropic drugs. The study sample comprised 45,616 adults and 1,476 youths. The investigators found that clozapine was associated with a 14% lower rate of rehospitalization in the adult cohort compared with other medications, although rehospitalization rates with clozapine were higher in the first 21 months of follow-up. There was a higher risk of adverse events in the adult population using clozapine. For children, clozapine resulted in a 38% lower relapse rate compared with other antipsychotics, with no between-group differences in the prevalence of adverse events. The study's authors wrote that “the benefit of clozapine may outweigh its adverse effects in certain patients and should probably be prescribed more often for cases that do not respond to other antipsychotics first.” [Balbuena, L., et al. (2024). Br J Psychiatry. https://doi.org/10.1192/bjp.2024.140]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".