Premorbid school performance trajectories in patients with treatment-resistant schizophrenia prescribed clozapine in the public health system in Chile: a case-control study, 2007–2020

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dc.catalogadorjwg
dc.contributor.authorConejeros Pavez, Jose Daniel Hernan
dc.contributor.authorBlanco Vasquez, Javiera Alejandra
dc.contributor.authorDiaz, Camila
dc.contributor.authorMena, Cristian
dc.contributor.authorUndurraga, Juan
dc.contributor.authorGonzalez-Valderrama, Alfonso
dc.contributor.authorClaro Larrain, Susana
dc.contributor.authorUndurraga Fourcade, Eduardo Andres
dc.contributor.authorCrossley, Nicolas A.
dc.date.accessioned2025-08-01T19:19:07Z
dc.date.available2025-08-01T19:19:07Z
dc.date.issued2025
dc.description.abstractBackgroundThe premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS.MethodsThis case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile’s public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders.ResultsWe included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (−0.26 SD [−0.2, −0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of −0.03; 95%CI −0.04, −0.01) and steeper quadratic decline than bipolar disorder (group×age2 of −0.005; −0.01, −0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia −0.03; −0.05, −0.01 and bipolar disorder −0.027; −0.049, −0.006).ConclusionsTRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target.
dc.description.abstractLong-term outcomes
dc.fuente.origenORCID
dc.identifier.doi10.1017/S0033291725101062
dc.identifier.urihttps://doi.org/10.1017/S0033291725101062
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/105098
dc.information.autorucInstituto de Sociología; Conejeros Pavez Jose Daniel Hernan; S/I; 222324
dc.information.autorucDepartamento de Ciencias de la Salud; Blanco Vasquez Javiera Alejandra; S/I; 1135701
dc.information.autorucEscuela de Gobierno; Claro Larrain Susana; 0000-0001-5168-4164; 11745
dc.information.autorucEscuela de Gobierno; Undurraga Fourcade Eduardo Andres; 0000-0002-4425-1253; 12868
dc.language.isoen
dc.nota.accesocontenido completo
dc.rightsacceso abierto
dc.subjectGlobal health
dc.subjectPremorbid academic achievement
dc.subjectPsychiatry
dc.subjectTreatment-resistant schizophrenia
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titlePremorbid school performance trajectories in patients with treatment-resistant schizophrenia prescribed clozapine in the public health system in Chile: a case-control study, 2007–2020
dc.typeartículo
sipa.codpersvinculados222324
sipa.codpersvinculados1135701
sipa.codpersvinculados11745
sipa.codpersvinculados12868
sipa.trazabilidadORCID;2025-07-28
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