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Zolezzi M, Eltorki Y. A brief history and challenges of clozapine utilization in the Arab world. Schizophr Res 2024; 268:21-24. [PMID: 37845137 DOI: 10.1016/j.schres.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Yassin Eltorki
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.
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2
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Srour A, Eltorki Y, Malik H, Alabdulla MA, Hassan MH, Ahmed Al Subaiey M, Michael Haddad P. Patients' and primary carers' views on clozapine treatment for schizophrenia: A cross-sectional study in Qatar. Saudi Pharm J 2023; 31:214-221. [PMID: 36942276 PMCID: PMC10023528 DOI: 10.1016/j.jsps.2022.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Subjective views of clozapine treatment among patients with schizophrenia in the Middle East and North African MENA Region have not previously been assessed. Globally, few studies have assessed the views of carers to clozapine treatment. We conducted a cross-sectional survey, using a clinician administered structured interview, of patients with schizophrenia/schizoaffective disorder prescribed clozapine in Qatar, and their primary carers. Participants were asked to rate clozapine against prior their antipsychotic treatment in terms of specific benefits and side effects. Forty-two patients and 33 carers participated in the study. Of the patients, two thirds were male, approximately half were Qatari and the mean age was 33.9 years. Patients and carers rated clozapine as superior to prior antipsychotic treatment on all 7 potential benefits inquired about. The greatest perceived benefit was improved mood. Patients rated clozapine as less likely to cause extrapyramidal side effects but more likely to cause 18 other potential side effects compared to prior antipsychotic treatment, with the greatest difference being for nocturnal salivation, increased appetite, and constipation. Nearly half of patients (48 %) and two thirds of carers (64 %) stated that they would have preferred to start clozapine earlier in their illness. Sixty percent of patients and 37 % of carers regarded the information that they had received from health professionals on clozapine as inadequate. Less than half of patients and approximately-two thirds of carers had adequate knowledge of haematological monitoring for clozapine. Generally, there were significantly positive correlation between patients and carers regarding the overall side effects of clozapine treatment. Likewise, improvement in hearing voices paranoid thoughts correlated with improved quality of life. In summary, the results show that patients and carers appreciate the benefits of clozapine despite its side effects being problematic. The results support clozapine being offered earlier in treatment and services providing more information on clozapine to patients and carers.
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Affiliation(s)
- Ahmad Srour
- Department of Psychiatry, Hamad Medical Corporation, Qatar
| | - Yassin Eltorki
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Pharmacy, Qatar University, Qatar
- Corresponding author at: Clinical Pharmacy Specialist, Mental Health Service, Pharmacy Department Hamad Medical Corporation, P.O.Box 3050, Doha, Qatar.
| | - Humayun Malik
- Department of Psychiatry, Hamad Medical Corporation, Qatar
| | - Majid A Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Medicine, Qatar University, Qatar
| | | | | | - Peter Michael Haddad
- Department of Psychiatry, Hamad Medical Corporation, Qatar
- College of Medicine, Qatar University, Qatar
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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3
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Rezaie L, Nazari A, Khazaie H. Exploration of the Barriers to Clozapine Prescribing in Patients with Treatment-Resistant Schizophrenia: A Qualitative Study. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 10:45-53. [PMID: 35967884 PMCID: PMC9362075 DOI: 10.1007/s40737-022-00287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022]
Abstract
Treatment-resistance schizophrenia (TRS) is one of the psychiatric challenges. While clozapine is an effective treatment for patients with TRS, there are some barriers to clozapine prescribing in these patients. The study aims to explore the barriers from Iranian psychiatrists' points of view. The study was conducted by a qualitative approach using content analysis. The Participants included 12 psychiatrists who were selected purposefully. Data were collected using a semi-structured interview from May to December 2020. All interviews were recorded and transcribed and analyzed qualitatively using constant comparisons. Three main categories emerged concerning barriers to the use of clozapine: drug-related barriers, psychiatrist and health system-related barriers, and patient and family-related barriers. Additionally, specific subcategories within each main category were documented. The present study showed that there are three main groups of barriers to the use of clozapine in patients with TRS. Psychiatrist and health system-related barriers may influence the other two groups of barriers. Further research to investigate the effective strategies to overcome the barriers is recommended.
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Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azadeh Nazari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Wadoo O, Latoo J, Alabdulla M, Eltorki Y, Riaz S, Karim MA, Abu-Hafizah M, Reagu S. Clozapine prescribing practice and trends in Qatar: First national observational study. Brain Behav 2022; 12:e2617. [PMID: 35647930 PMCID: PMC9304832 DOI: 10.1002/brb3.2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/13/2022] [Accepted: 04/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clozapine is the gold standard in the management of treatment-resistant schizophrenia. Despite its clinically proven efficacy clozapine utilization is variable globally and published evidence is suggestive of its underutilization. Research from the Arab region on clozapine utilization is limited. The aim of our descriptive observational study was to evaluate the prescribing practice of clozapine and its sociodemographic and clinical corelates in the State of Qatar. METHODS The study is a retrospective case-note review of all patients maintained on clozapine, in the calendar year 2020. Data were collected on sociodemographic characteristics of the patients; antipsychotic trials before initiating clozapine; and clinical characteristics of the patients, including their diagnoses leading to prescription of clozapine, duration of illness, psychiatric hospitalizations, and co-morbidities. RESULTS During the study period, 100 patients were maintained on clozapine. Patients were mostly Qatari and non-Qatari Arab males. Prescription rates were significantly different for Qatari patients when compared to non-Qatari patients. Most patients had a chronic illness with the age of onset of illness in early adulthood and were diagnosed with schizophrenia or schizoaffective disorder. The mean daily dose of clozapine was 325 mg. Eighty percent of the patients received two or more antipsychotic trials before initiating clozapine. Sixty-eight percent of the patients had more than two antipsychotic trials before initiating Clozapine. One third of patients had no history of psychiatric hospitalizations, and one quarter had five or more previous psychiatric hospitalizations. Of the psychiatric comorbidities, mood and substance use disorders were common. Of medical comorbidities, endocrine and metabolic disorders were common. CONCLUSION Despite apparent underutilization, the Clozapine prescribing rates in Qatar are comparable to countries with plasma monitoring systems when framed within Qatar's unique demographic context. However, there still is a significant delay in Clozapine initiation despite its clinical superiority. STRENGTHS AND LIMITATIONS OF THIS STUDY First study on Clozapine utilization from the Middle-East and North-Africa region. This study examined prescribing of clozapine in a national cohort of patients in Qatar. Provides insight into sociodemographic and clinical correlates of clozapine prescribing in a country with 90% migrants. Limited by the completeness of the information contained in the patients' medical charts.
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Affiliation(s)
- Ovais Wadoo
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| | - Javed Latoo
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Majid Alabdulla
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| | - Yassin Eltorki
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Sadaf Riaz
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Abdul Karim
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Department of Psychiatry, College of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Shuja Reagu
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Department of Psychiatry, College of Medicine, Weill Cornell Medicine, Doha, Qatar
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Hassab Errasoul A, Alarabi MA. Factors predicting serum clozapine levels in Middle Eastern patients: an observational study. BMC Psychiatry 2022; 22:269. [PMID: 35428222 PMCID: PMC9011948 DOI: 10.1186/s12888-022-03910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite its superiority over other drugs for psychosis, clozapine remains underused and is associated with many clinical challenges, including difficulties in predicting therapeutic serum levels (350-600 ng/mL). We found no large or recent study that investigated the determinants of serum clozapine levels in Middle Eastern patients. Therefore, we investigated the association between clozapine dose and serum level, and the clinical predictors of the clozapine serum level, in Middle Eastern patients. METHODS This cross-sectional study included 94 patients of Middle Eastern ethnicity who attended the Clozapine Clinic in King Saud University Medical City in Riyadh, Saudi Arabia. We used a single measure of the serum clozapine level, which was collected 12 h after the last oral dose of clozapine under steady-state conditions. RESULTS The average clozapine dose and serum level were 400 mg/daily and 705 ng/mL, respectively. The majority of patients (59.8%) had serum levels higher than 600 ng/mL. Clozapine dose and serum level were positively correlated (rs [94] = 0.32, p = 0.002). We generated a predictive model of the serum clozapine level, which revealed that the daily dose, smoking status, use of fluvoxamine or lamotrigine, and body mass index (BMI) predicted 43.6% of the variance in the serum level (p < 0.001). Using this model, we calculated that patients with a BMI of 25 kg/m2 would require a clozapine dose between 50 to 275 mg/daily if they were non-smokers, and a dose of 200 to 450 mg/daily if they were smokers, in order to reach a serum clozapine level between 350 to 600 ng/mL. Patients with higher BMI and those receiving fluvoxamine would require lower doses. CONCLUSIONS This was a naturalistic study of the clozapine dose-level relationship and the clinical predictors of the serum clozapine level in a sample of Middle Eastern patients. The ratios of clozapine level to dose in our patients more closely resembled those reported in Asian samples than in European samples. These findings do not reduce the value of individualised therapeutic drug monitoring, but may assist clinicians when prescribing clozapine to Middle Eastern patients. Further psychopharmacological studies are needed on this demographic population.
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Affiliation(s)
- Ahmed Hassab Errasoul
- grid.56302.320000 0004 1773 5396Department of Psychiatry, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472 Kingdom of Saudi Arabia
| | - Mohammed A. Alarabi
- grid.56302.320000 0004 1773 5396Department of Psychiatry, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472 Kingdom of Saudi Arabia
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Baig AI, Bazargan-Hejazi S, Ebrahim G, Rodriguez-Lara J. Clozapine prescribing barriers in the management of treatment-resistant schizophrenia: A systematic review. Medicine (Baltimore) 2021; 100:e27694. [PMID: 34766570 PMCID: PMC10545051 DOI: 10.1097/md.0000000000027694] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Treatment-resistant schizophrenia is prevalent and difficult to manage, as patients fail multiple antipsychotic trials before being considered as treatment-resistant. Currently clozapine is the only Food and Drug Administration-approved pharmacotherapy for treatment-resistant schizophrenia but remains under-prescribed. The purpose of this study is to investigate recent literature on clozapine in order to identify barriers to prescribing clozapine and categorize the recommended solutions. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using free text and the medical subject headings, we searched MEDLINE/PubMed electronic bibliographic database from 2017 until 2020. Eligible studies included peer-reviewed English language articles with multiple methodologies aiming to identify clozapine barriers in treatment-resistant schizophrenia. We used search terms combining clozapine AND treatment OR treatment-resistant schizophrenia AND barriers AND prescribing OR prescription OR prescriber. We merged search results in a citation manager software, removed duplicates, and screened the remaining articles based on the study eligibility criteria. RESULTS We retrieved 123 studies, however, only 10 articles exclusively met the study inclusion criteria for full text review. These studies represented 20 countries; 6 were exclusively conducted in the US. The top barriers delineated by the studies include: providers' lack of knowledge and training (n = 7), concern about side effects (n = 8), and poor adherence (n = 7). All studies described more than 1 barrier. Other barriers included prescriber-perceived barriers (n = 4), administrative barriers (n = 5), and other healthcare systems-related barriers (n = 3). Top recommendations to overcome clozapine prescription barriers included improving prescriber clozapine education/training, utilizing interdisciplinary teams and providing integrated care via clozapine clinics, and simplifying blood test monitoring. CONCLUSION Clozapine remains under-prescribed for patients with treatment-resistant schizophrenia due to multiple barriers related to the individual prescriber, system of care, and technology. It is recommended that by improving prescriber knowledge and training, use of integrated care, and use of technology that can enable continuous, real-time blood test monitoring, these barriers may be overcome.
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Affiliation(s)
- Anum Iqbal Baig
- College of Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
- David Geffen School of Medicine, University of California at Los Angeles, CA
| | - Gul Ebrahim
- College of Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - Jaziel Rodriguez-Lara
- College of Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
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Laforgue EJ, Istvan M, Guerlais M, Chaslerie A, Artarit P, Vallot G, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. What about regular hematological monitoring during clozapine treatment? A compliance analysis using the French health insurance database. Expert Opin Drug Saf 2021; 20:1247-1256. [PMID: 34085879 DOI: 10.1080/14740338.2021.1939304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The inherent risk of agranulocytosis associated with clozapine requires the realization of weekly white blood cell monitoring (WBCM) during the 18 first weeks of treatment. The aim of this study was to assess the compliance with WBCM during clozapine initiation for schizophrenia and Parkinson's disease (PD) subjects. RESEARCH DESIGN AND METHOD The analysis was conducted using SNDS data on a cohort of new users of clozapine in 2018. We analyzed all reimbursements for WBCM from 2 weeks before the index date to 18 weeks after (optimal monitoring during hospitalization was assumed). The primary outcome was the proportion of good realization of WBCM according to different thresholds of completion (70%; 80%; 90%). Descriptive and comparative analyses with chi-squared test or Student's t-test were performed. RESULTS Two hundred and ninety-six subjects were included. Rates of patients with WBCM realization over 70%, 80%, and 90% of WBCM expected were, respectively, 78.1%, 70.0%, and 56.9% for subjects with schizophrenia and 71.3%, 63.2%, and 47.8% for PD subjects. Only hospitalization during the follow-up period for schizophrenia subjects was significantly associated with good WBCM realization. CONCLUSIONS We observed rather good results for compliance with clozapine initial monitoring. Other studies are needed to confirm our results.
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Affiliation(s)
- Edouard-Jules Laforgue
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR 1246 SPHERE (Methods in Patients-centered Outcomes and HEalth Research), Nantes and Tours Universities, France
| | - Marion Istvan
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR 1246 SPHERE (Methods in Patients-centered Outcomes and HEalth Research), Nantes and Tours Universities, France
| | - Marylène Guerlais
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Anicet Chaslerie
- Medical Department, French Health Insurance System, Nantes, France
| | - Pascal Artarit
- Medical Department, French Health Insurance System, Nantes, France
| | - Genevieve Vallot
- Medical Department, French Health Insurance System, Nantes, France
| | - Pascale Jolliet
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR 1246 SPHERE (Methods in Patients-centered Outcomes and HEalth Research), Nantes and Tours Universities, France
| | - Marie Grall-Bronnec
- INSERM UMR 1246 SPHERE (Methods in Patients-centered Outcomes and HEalth Research), Nantes and Tours Universities, France.,Addictology and Liaison-Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Caroline Victorri-Vigneau
- Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR 1246 SPHERE (Methods in Patients-centered Outcomes and HEalth Research), Nantes and Tours Universities, France
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8
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Wadoo O, Karim MA, ElTorki Y, Riaz S, Latoo J, Alabdulla M. Clozapine prescribing and safety during COVID-19. Asian J Psychiatr 2021; 60:102658. [PMID: 33895435 PMCID: PMC8035804 DOI: 10.1016/j.ajp.2021.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | - Majid Alabdulla
- Hamad Medical Corporation, Qatar; College of Medicine Qatar University, Qatar.
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9
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Whiskey E, Barnard A, Oloyede E, Dzahini O, Taylor DM, Shergill SS. An evaluation of the variation and underuse of clozapine in the United Kingdom. Acta Psychiatr Scand 2021; 143:339-347. [PMID: 33501659 DOI: 10.1111/acps.13280] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clozapine is the only licensed treatment for treatment refractory schizophrenia. Despite this, it remains grossly underused relative to the prevalence of refractory schizophrenia. The extent of underuse and the degree of regional variation in prescribing in the United Kingdom is unknown. It is also unclear, how the UK compares with other European countries in rates of clozapine prescribing. METHODS We obtained data relating to all clozapine prescribing in the UK from the relevant clozapine registries. We examined regional variation in clozapine use across England, corrected for the known prevalence of severe mental illness (SMI). We also compared the UK rate of clozapine use per 100,000 population to that described in other European countries. FINDINGS There is substantial variation in clozapine prescribing across different regions of England and only about a third of potentially eligible patients were prescribed the drug in the UK. Clozapine prescribing rate in the UK was lower than in several European countries. INTERPRETATION There is clear regional inequity in access to the most effective treatment in refractory schizophrenia in England. Strategies to increase clozapine use, by overcoming both real and perceived barriers, are urgently necessary to reduce treatment inequity for patients with refractory schizophrenia.
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Affiliation(s)
- Eromona Whiskey
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
| | - Alex Barnard
- Clinical Research Network CRN, National Institute for Health Research NIHR, London, UK
| | - Ebenezer Oloyede
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
| | - Olubanke Dzahini
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK
| | - David M Taylor
- Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Sciences, King's College, London, UK
| | - Sukhwinder S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, Kings College, London, UK
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10
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Ouanes S, Becetti I, Ghuloum S, Hammoudeh S, Shehata M, Ghabrash H, Yehya A, Al-Lawati H, Al-Fakhri N, Iram H, Ajmal N, Eltorki Y, Al-Amin H. Patterns of prescription of antipsychotics in Qatar. PLoS One 2020; 15:e0241986. [PMID: 33166337 PMCID: PMC7652328 DOI: 10.1371/journal.pone.0241986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This study aimed to examine the prescription patterns of antipsychotics in Qatar, in comparison with the international guidelines, and to scrutinize the sociodemographic and clinical features associated with antipsychotic polypharmacy. METHODS All the medical records of all the inpatients and outpatients treated by antipsychotics at the Department of Psychiatry-Hamad Medical Corporation (HMC) in Doha, Qatar (between October 2012 and April 2014) were retrospectively analyzed. We retrieved the available sociodemographic data, psychiatric features, and details on the medication history. RESULTS Our sample consisted of 537 individuals on antipsychotics (2/3 were male; mean age 33.8±10.2 years), prescribed for a psychotic disorder in 57%, a mood disorder in 9.3%, and various other diagnoses in 33.7%. About 55.9% received one antipsychotic, 29.6% received two antipsychotics, and 14.5% received more than two antipsychotics. Polypharmacy was associated with younger age (p = 0.025), being single (p<0.001), the diagnosis of a psychotic disorder (p<0.001), and previous admissions to psychiatry (p<0.001). CONCLUSIONS Antipsychotic polypharmacy appears to be quite common in Qatar, as it is the case in many other countries, in contrast with most international recommendations. Studies are needed to explore the reasons behind this disparity.
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Affiliation(s)
- Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Imen Becetti
- Weill Cornell Medical College, Medical Education, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Samer Hammoudeh
- Research Department, Weill Cornell Medical College, Doha, Qatar
| | - Mena Shehata
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Hany Ghabrash
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Areej Yehya
- Research Department, Weill Cornell Medical College, Doha, Qatar
| | - Hawra Al-Lawati
- Weill Cornell Medical College, Medical Education, Doha, Qatar
| | - Nora Al-Fakhri
- Weill Cornell Medical College, Medical Education, Doha, Qatar
| | - Huma Iram
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Nighat Ajmal
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Yassin Eltorki
- Pharmacy Department, Hamad Medical Corporation, Psychiatry Hospital, Doha, Qatar
| | - Hassen Al-Amin
- Psychiatry Department, Weill Cornell Medical College, Doha, Qatar
- * E-mail:
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11
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Frequency, reasons, and factors associated with antipsychotic polypharmacy in Schizophrenia: A retrospective chart review in a tertiary hospital in India. Asian J Psychiatr 2020; 51:102022. [PMID: 32278888 DOI: 10.1016/j.ajp.2020.102022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
The practice of antipsychotic polypharmacy in schizophrenia appears to be common although evidence-based guidelines do not routinely recommend it. The reasons for polypharmacy are however unclear. The objective of the study was to assess the frequency of polypharmacy, reasons for initiation and the factors associated with it. A retrospective chart review of case records of all the patients diagnosed with schizophrenia at the department of psychiatry from January 2011 to December 2018 was done. Frequency of antipsychotic polypharmacy, reasons influencing it and factors associated with polypharmacy were extracted using a proforma. Of 529 patients diagnosed with schizophrenia, 232 patients (43.9 %) were receiving antipsychotic polypharmacy. Common reasons for polypharmacy included the usage of depot along with oral antipsychotic for a prolonged period (37.7 %), augmentation of response with the second antipsychotic (17.7 %) and treatment of a different symptom domain like negative symptoms (9.5 %). In comparison to monopharmacy, antipsychotic polypharmacy was more commonly associated with side effects and extrapyramidal symptoms. Patients on polypharmacy had a higher number of hospitalizations too. As the trend of antipsychotic polypharmacy is on the rise, it is important to assess for reasons influencing polypharmacy to avoid undesirable side effects. The side effect burden of polypharmacy is significantly more than those receiving single antipsychotics. Oral antipsychotics should ideally be discontinued after the depot antipsychotic reaches steady-state levels. Irrational usage of second antipsychotic to augment the response of first antipsychotic agent needs to be avoided.
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12
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Abstract
OBJECTIVE Clozapine is the only approved strategy for treatment-resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence-based recommendations for the use of this drug considering prescription barriers. METHOD Narrative review. RESULTS A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence-based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. CONCLUSION Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.
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Affiliation(s)
- J M Rubio
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Northwell Health, Glen Oaks, NY, USA.,The Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
| | - J M Kane
- Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY, USA.,Feinstein Institute for Medical Research, Northwell Health, Glen Oaks, NY, USA.,The Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
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13
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Prescription of antipsychotic and concomitant medications for adult Asian schizophrenia patients: Findings of the 2016 Research on Asian Psychotropic Prescription Patterns (REAP) survey. Asian J Psychiatr 2019; 45:74-80. [PMID: 31520884 DOI: 10.1016/j.ajp.2019.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/11/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Regular surveys are important to monitor the use of psychotropic medications in clinical practice. This study examined the psychotropic prescription patterns in adult Asian schizophrenia patients based on the data of the Research on Asian Psychotropic Prescription (REAP) 2016 survey. METHODS This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire. RESULTS Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ± 11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ± 376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics. CONCLUSIONS Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.
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Compagni C, Salvi V, Corulli M, Rosso R, Gramaglia C. Clozapine-induced eosinopenia correlates with high drug serum levels: A case report. Asian J Psychiatr 2019; 43:83-84. [PMID: 31100604 DOI: 10.1016/j.ajp.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/14/2019] [Accepted: 04/22/2019] [Indexed: 12/16/2022]
Affiliation(s)
- C Compagni
- Maternal and Child Department, S.C. of Child and Adolescent Neuropsychiatry Nord, ASL Città di Torino, Torino, Italy.
| | - V Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Corulli
- Unit for Psychotic Disorders, Therapeutic Community "Il Porto" ONLUS, Moncalieri, TO, Italy
| | - R Rosso
- Unit for Psychotic Disorders, Therapeutic Community "Il Porto" ONLUS, Moncalieri, TO, Italy
| | - C Gramaglia
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, SC Psychiatry, AOU Maggiore della Carità, Novara, Italy
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Tunsirimas N, Pariwatcharakul P, Choovanichvong S, Ratta-Apha W. Clozapine-induced agranulocytosis and leukopenia: Incidence, associated factors, and rate of hematologic adverse-effects monitoring in psychiatric out-patient services in Thailand. Asian J Psychiatr 2019; 41:13-16. [PMID: 30856469 DOI: 10.1016/j.ajp.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 01/21/2023]
Abstract
The present study aimed to investigate the incidence of agranulocytosis and leukopenia and its associated factors in Thai schizophrenia patients treated with clozapine and the rate of hematologic adverse events monitored in clinical practice. Data were collected from the medical records of 641 outpatients at two hospitals. The results showed no cases of agranulocytosis and 20 cases of leukopenia (3.1%), 85% of which were observed after 1 year of prescription. The associated factors were female (p = 0.019) and duration of clozapine prescription (p = 0.026). According to the guideline for safety monitoring, 23.6% of cases had neutrophils count monitoring.
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Affiliation(s)
- Noppawan Tunsirimas
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Nakorn Ratchasima Rajanagarindra Psychiatric Hospital, Nakorn Ratchasima, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Hatta K, Hasegawa H, Imai A, Sudo Y, Morikawa F, Katayama S, Watanabe H, Ishizuka T, Nakamura M, Misawa F, Fujita K, Ozaki S, Umeda K, Nakamura H, Sawa Y, Sugiyama N. Real-world effectiveness of antipsychotic monotherapy and polytherapy in 1543 patients with acute-phase schizophrenia. Asian J Psychiatr 2019; 40:82-87. [PMID: 30772732 DOI: 10.1016/j.ajp.2019.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The effectiveness of antipsychotic treatments in the acute phase of schizophrenia in actual clinical practice remains somewhat unclear. Therefore, the purpose of the present naturalistic, multi-center study conducted from 1 year starting in September 2017 was to examine the response rate to an initial or second antipsychotic in newly admitted patients with acute-phase schizophrenia, as well as the response rate and quality of augmentation with two antipsychotics in patients who failed to respond to both the initial and second antipsychotics. RESULTS In total, there were 660 (42.8%) and 243 (15.7%) responders to an initial and a second antipsychotic, respectively; thus, 58.5% of all patients were responders to an initial or second antipsychotic. Among 581 nonresponders (37.7%), the initial antipsychotic or a third antipsychotic was added to the second antipsychotic. Among these patients, 89.8% showed a Clinical Global Impression-Improvement score ≤3 (from 'minimally improved' to 'very much improved'). The rates of adverse events such as hyperglycemia, hyper-low-density lipoprotein cholesterolemia, hypertriglyceridemia, hyperprolactinemia, QTc prolongation, and extrapyramidal symptoms were not high in patients receiving augmentation with two antipsychotics compared with all patients, and no serious adverse events were reported. CONCLUSION Antipsychotic augmentation may be an option in acute-phase treatment for patients who do not respond to either an initial or a second antipsychotic.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan.
| | - Hana Hasegawa
- Department of Psychiatry, Numazu Chuo Hospital, Numazu, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yasuhiko Sudo
- Department of Psychiatry, Tosa Hospital, Kochi, Japan
| | - Fumiyoshi Morikawa
- Department of Psychiatry, Asahikawa Keisenkai Hospital, Asahikawa, Japan
| | | | | | | | | | - Fuminari Misawa
- Department of Psychiatry, Yamanashi Prefectural Kita Hospital, Nirasaki, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, The Okehazama Hospital, Toyoake, Japan
| | - Shigeru Ozaki
- Department of Psychiatry, Toshima Hospital, Tokyo, Japan
| | - Kentaro Umeda
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yutaka Sawa
- Department of Psychiatry, Sawa Hospital, Osaka, Japan
| | - Naoya Sugiyama
- Department of Psychiatry, Numazu Chuo Hospital, Numazu, Japan
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