Clozapine underutilization in Saudi Arabia: insights from a national survey of psychiatrists and implications for clinical training and practice.

OBJECTIVE

To examine psychiatrists' prescribing patterns, attitudes, and knowledge regarding clozapine use in Saudi Arabia, and to identify factors associated with clozapine prescribing.

METHODS

A cross-sectional survey was distributed to psychiatrists and trainees across Saudi Arabia between January and June 2024. The questionnaire assessed demographics, prescribing patterns, attitudes, and clinical decision-making regarding clozapine. Descriptive statistics summarised responses, and comparisons between consultants and trainees were conducted using chi-square and t-tests. Binary logistic regression was applied to identify independent predictors of clozapine prescribing.

RESULTS

Ninety-seven psychiatrists participated; 69.1% had prescribed clozapine during the previous year. Consultants were significantly more likely than trainees to prescribe clozapine (p = 0.012). The majority (79.4%) agreed that clozapine is the most effective antipsychotic, yet 71% viewed its initiation as an administrative burden. Only 42.3% reported confidence in managing side effects, and 36.1% indicated access to clozapine-specific clinics. Logistic regression showed that perceiving clozapine initiation as an administrative burden significantly reduced the likelihood of prescribing (B = -1.44, p = 0.045, OR = 0.24, 95% CI = 0.06-0.97).

CONCLUSIONS

Despite high awareness of clozapine's efficacy, administrative and structural barriers continue to limit its use among psychiatrists in Saudi Arabia.