Knowledge, Skills, Attitudes, and Perceived Barriers Related to Clozapine Use Among Child and Adolescent Psychiatry Professionals: A Cross-Sectional Survey

Objectives/Background: Clozapine is the treatment of choice for treatment-resistant schizophrenia (TRS), yet it remains underutilized in child and adolescent psychiatry. This study aimed to assess knowledge, clinical skills, attitudes, and perceived barriers related to clozapine use among child and adolescent psychiatry professionals in Türkiye. Methods: A cross-sectional online survey was distributed to child and adolescent psychiatry residents, specialists, and academics across Türkiye via professional email lists and messaging groups. The questionnaire assessed sociodemographic characteristics, clozapine prescribing experience, perceived barriers, self-rated competence, training exposure, and attitudes toward clozapine. Group comparisons were performed using chi-square tests. Results: A total of 517 professionals participated (180 residents, 212 specialists, and 125 academics). Only 30.0% had prescribed clozapine in the past 12 months, and 28.6% had received specific clozapine training. Barriers were common across all groups, with concerns about medication adherence (43.2%–58.0%), blood test compliance (56.8%–65.6%), and side effects being most frequently endorsed. A clear experience-related gradient emerged: residents reported significantly more barriers, lower self-rated competence, and greater reluctance to prescribe than specialists and academics. Clinicians without inpatient access reported more barriers and lower confidence and were less likely to have gained meaningful clozapine experience during residency (35.2% vs. 66.0%, p < 0.001) or to have observed clozapine’s superiority firsthand (57.7% vs. 79.7%, p < 0.001). Despite these barriers, 92.3% of respondents acknowledged clozapine’s superior efficacy compared with other antipsychotics. Conclusions: This nationwide survey, the largest to examine clozapine-related attitudes among child and adolescent psychiatry professionals globally, reveals substantial gaps in training, confidence, and service infrastructure in Türkiye. While efficacy is widely recognized, safety concerns and monitoring-related barriers, particularly among less experienced clinicians and those without inpatient access, limit appropriate prescribing. Findings underscore the unmet need for structured residency training programs, national clinical guidelines, and expanded service infrastructure to ensure equitable access to clozapine for youth with TRS.