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Jakobsen MI, Austin SF, Storebø OJ, Nielsen J, Simonsen E. Non-prescribing of clozapine for outpatients with schizophrenia in real-world settings: The clinicians' perspectives. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:91. [PMID: 38135678 PMCID: PMC10746712 DOI: 10.1038/s41537-023-00423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Clozapine is the gold standard for treating treatment-resistant schizophrenia although continuously underutilized. Previous surveys of clinicians have found that some of the most frequently cited barriers to clozapine prescribing are related to the blood-monitoring requirements. However, these surveys tend to explore general perspectives and may not reflect the true impact of different barriers in real-world outpatient settings. This study aimed to explore this issue. First, by surveying the clinicians responsible for the treatment of 39 clozapine-eligible, yet clozapine-naive, outpatients with schizophrenia. Then, based on the survey results, explanatory interviews with the participating psychiatrists were conducted and analyzed thematically. The most frequently cited reason for non-prescribing of clozapine was the expected non-compliance with blood-monitoring requirements; however, overall stability and/or severe mental illness was chosen as the most important reason in most patient-cases. The qualitative analysis highlighted the combined impact of standard clinical practice, personal experiences, and organizational constraints on clozapine utility.
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Grants
- This study is part of a PhD project funded by the Mental Health Services of Region Zealand Psychiatry East, Roskilde, Denmark, The Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark, and the Psychiatric Centre Glostrup, Unit for Complicated Schizophrenia, the Mental Health Services of The Capital Region of Denmark, in collaboration. Due to the funding by the Psychiatric Research Unit, Region Zealand Psychiatry, the study is partially funded by a private donation favoring patient-oriented research within the region.
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Affiliation(s)
- Michelle Iris Jakobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Psychiatric Research Unit East, Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark.
| | - Stephen Fitzgerald Austin
- Psychiatric Research Unit East, Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark
- The Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Ole Jakob Storebø
- The Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Centre Glostrup, Unit for Complicated Schizophrenia, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit East, Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark
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2
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Laforgue EJ, Istvan M, Chaslerie A, Artarit P, Vallot G, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data. Epidemiol Psychiatr Sci 2023; 32:e59. [PMID: 37723967 PMCID: PMC10539739 DOI: 10.1017/s2045796023000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023] Open
Abstract
AIMS Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. METHODS Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017-2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. RESULTS The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of 'less treated' younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of 'more treated' individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of 'treatment-stable' older individuals with longer TT durations. CONCLUSIONS The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Anicet Chaslerie
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Pascal Artarit
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Geneviève Vallot
- Medical Department, Regional Health Insurance Pays de la Loire, Nantes, France
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique, Nantes Université, Nantes, France
- CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes Université, Univ Tours, Nantes, France
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3
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Jakobsen MI, Schaug JP, Nielsen J, Simonsen E. Antipsychotic prescribing practices for outpatients with schizophrenia and reasons for non-clozapine treatment - Data from a Danish quality assessment audit. Nord J Psychiatry 2023:1-10. [PMID: 36651766 DOI: 10.1080/08039488.2022.2160878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clozapine is the gold standard for treating treatment-resistant schizophrenia (TRS) although widely underutilised. Both organisational, patient- and clinician related reasons for the underutilisation have been reported, however, the clinical impact of either in real-world settings is not fully elucidated. AIM This audit aimed to evaluate the local antipsychotic (AP) prescribing practices for outpatients with schizophrenia and to assess the spectrum and prevalence of journalised reasons for non-clozapine treatment amongst eligible outpatients. METHODS Data on demographics, current and former AP treatments, as well as documented reasons for non-clozapine treatment, was extracted through chart audit. RESULTS Of the 668 affiliated outpatients with schizophrenia, 43% were treated with AP polytherapy (APP) and 19.6% with clozapine. The most prevalent reason for clozapine discontinuation was related to side effects whereas the most prevalent reason for refusal or omission of clozapine treatment was related to the associated monitoring regimen. CONCLUSIONS This audit showed that APP prescribing is a highly prevalent practice in our services when treating outpatients with schizophrenia and that clozapine is underutilised in a 'last resort' manner. The blood-monitoring regimen associated with clozapine treatment was found to be an important factor in the underutilisation. It seemed, however, that the monitoring constituted a barrier for different reasons, requiring different approaches to remedy. Future studies, directly involving both patients and clinicians in the identification and management of the most clinically relevant barriers and their corresponding facilitators, are warranted.
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Affiliation(s)
- Michelle I Jakobsen
- The Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie P Schaug
- Psychiatric Research Unit, Centre for Evidence-Based Psychiatry, Region Zealand Psychiatry, Slagelse, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Glostrup, The Mental Health Services in the Capital Region of Denmark, Glostrup, Denmark
| | - Erik Simonsen
- The Mental Health Services East, Region Zealand Psychiatry, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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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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Pai N, Acar M, Juneja P, Kouhkamari MH, Siva S, Mullan J. Antipsychotic prescribing patterns in Australia: a retrospective analysis. BMC Psychiatry 2022; 22:110. [PMID: 35148707 PMCID: PMC8840322 DOI: 10.1186/s12888-022-03755-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To examine real-world patterns of antipsychotic use in patients with schizophrenia Australia. METHODS This retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample data. Included data were for patients aged 16-years or older who initiated treatment for the first time with a PBS-reimbursed antipsychotic medication for schizophrenia between July 2013 and September 2017. Patterns of treatment usage were summarised descriptively. Differences in prescribing patterns by age and prescribing year were reported. Treatment persistence was estimated using Kaplan-Meier methods, with differences explored using log-rank tests. Values of p < 0.05 were considered statistically significant. RESULTS 6,740 patients, representing 8,249 non-unique patients, received prescriptions for antipsychotic medications. Patients were aged 16 years to over 85 years (54.5% were < 55 years) and two-thirds of patients were male (61%). The majority of treatment episodes (62%, n = 5,139/8,249) were prescribed an atypical oral antipsychotic. Typical long-acting antipsychotic therapies (LATs) were prescribed 19% of the treatment episodes (n = 1,608/8,249. There was a small increase in prescribing of atypical LAT and typical LAT and a small decrease in atypical oral and clozapine prescribing over the study period. Treatment persistence was greatest in patients treated with clozapine, than in those treated with atypical LATs. CONCLUSIONS While the majority of patients receive atypical antipsychotic medications, one in five continue to use older typical LAT therapies. Patient age and time on therapy may be associated with choice of therapy. Persistence to atypical LAT therapy is better than for other treatment modalities in this real-world cohort.
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Affiliation(s)
- Nagesh Pai
- School of Medicine, University of Wollongong (UOW), Wollongong, Australia. .,Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.
| | - Mustafa Acar
- Janssen-Cilag Pty Ltd, North Ryde, NSW Australia
| | | | | | | | - Judy Mullan
- grid.1007.60000 0004 0486 528XSchool of Medicine, University of Wollongong (UOW), Wollongong, Australia
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6
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Garriga M, Mallorquí A, Bernad S, Ruiz-Cortes V, Oliveira C, Amoretti S, Mezquida G, Bioque M, Molina O, Gómez-Ramiro M, Vieta E, Bernardo M, Parellada E, García-Rizo C. Antipsychotic-Associated Weight Gain and Clinical Improvement Under Clozapine Treatment. J Clin Psychopharmacol 2022; 42:75-80. [PMID: 34928563 DOI: 10.1097/jcp.0000000000001483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotic-associated weight gain is a common adverse effect with several negative outcomes in the clinical evolution of patients, which might also affect patients' self-identity from physical appearance and imply treatment discontinuation. However, recent research has drawn attention to an unexpected clinical improvement associated with weight gain, mostly in patients under treatment with clozapine or olanzapine. METHODS Twenty-three treatment-resistant psychosis patients initiating clozapine were evaluated. Longitudinal psychopathological assessment through the Positive and Negative Syndrome Scale (PANSS) and anthropometric evaluation were performed at baseline, week 8, and 18. RESULTS Body mass index (BMI) change during clozapine treatment was associated with clinical improvement measured with PANSS total score at week 8 (P = 0.021) while showed a trend at week 18 (P = 0.058). The PANSS general score was also associated with weight gain at week 8 (P = 0.022), whereas negative subscale score showed a trend at week 8 (P = 0.088) and was associated between week 8 and 18 (P = 0.018). Sex differences applied at week 8 for PANSS total score, where clinical improvement was significantly associated with BMI in male subjects (P = 0.024). We also stratified for time to initiate clozapine, finding significant associations in negative symptom at week 8 (P = 0.023) and week 18 (P = 0.003) for subjects, which started clozapine after 3 years of illness. CONCLUSIONS Our results suggest that in subjects initiating clozapine, clinical improvement is associated with BMI increase, mostly in negative symptom and in patients after 3 years of antipsychotic use. Our findings were already described in the preantipsychotic era, suggesting some pathophysiological mechanism underlying both conditions.
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Affiliation(s)
| | - Andrea Mallorquí
- Clinical Institute of Neurosciences, Hospital Clínic of Barcelona
| | - Sonia Bernad
- Clinical Institute of Neurosciences, Hospital Clínic of Barcelona
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7
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Patrón de uso de clozapina en España. Variabilidad e infraprescripción. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:151-162. [DOI: 10.1016/j.rpsm.2018.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 01/22/2023]
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Abstract
Clozapine is the first second generation antipsychotic with different receptor profile of action. Clozapine is the most efficacious drug for the treatment of psychotic disorder and is the drug of choice in treatment resistant schizophrenia. Clozapine is used in elderly patients infrequently owing to its adverse effects profile and tolerability. There is paucity of literature with respect to clozapine use in late life. In this narrative review, we discuss clozapine use in elderly and challenges associated with its use.
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Affiliation(s)
- Shiva Shanker Reddy Mukku
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - P T Sivakumar
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
| | - Mathew Varghese
- Geriatric Clinic & Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, 560029, India.
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9
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The Differential Binding of Antipsychotic Drugs to the ABC Transporter P-Glycoprotein Predicts Cannabinoid-Antipsychotic Drug Interactions. Neuropsychopharmacology 2017; 42:2222-2231. [PMID: 28272498 PMCID: PMC5603813 DOI: 10.1038/npp.2017.50] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 12/11/2022]
Abstract
Cannabis use increases rates of psychotic relapse and treatment failure in schizophrenia patients. Clinical studies suggest that cannabis use reduces the efficacy of antipsychotic drugs, but there has been no direct demonstration of this in a controlled study. The present study demonstrates that exposure to the principal phytocannabinoid, Δ9-tetrahydrocannabinol (THC), reverses the neurobehavioral effects of the antipsychotic drug risperidone in mice. THC exposure did not influence D2 and 5-HT2A receptor binding, the major targets of antipsychotic action, but it lowered the brain concentrations of risperidone and its active metabolite, 9-hydroxy risperidone. As risperidone and its active metabolite are excellent substrates of the ABC transporter P-glycoprotein (P-gp), we hypothesized that THC might increase P-gp expression at the blood-brain barrier (BBB) and thus enhance efflux of risperidone and its metabolite from brain tissue. We confirmed that the brain disposition of risperidone and 9-hydroxy risperidone is strongly influenced by P-gp, as P-gp knockout mice displayed greater brain concentrations of these drugs than wild-type mice. Furthermore, we demonstrated that THC exposure increased P-gp expression in various brain regions important to risperidone's antipsychotic action. We then showed that THC exposure did not influence the neurobehavioral effects of clozapine. Clozapine shares a very similar antipsychotic mode of action to risperidone, but unlike risperidone is not a P-gp substrate. Our results imply that clozapine or non-P-gp substrate antipsychotic drugs may be better first-line treatments for schizophrenia patients with a history of cannabis use.
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10
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Bachmann CJ, Aagaard L, Bernardo M, Brandt L, Cartabia M, Clavenna A, Coma Fusté A, Furu K, Garuoliené K, Hoffmann F, Hollingworth S, Huybrechts KF, Kalverdijk LJ, Kawakami K, Kieler H, Kinoshita T, López SC, Machado-Alba JE, Machado-Duque ME, Mahesri M, Nishtala PS, Piovani D, Reutfors J, Saastamoinen LK, Sato I, Schuiling-Veninga CCM, Shyu YC, Siskind D, Skurtveit S, Verdoux H, Wang LJ, Zara Yahni C, Zoëga H, Taylor D. International trends in clozapine use: a study in 17 countries. Acta Psychiatr Scand 2017; 136:37-51. [PMID: 28502099 DOI: 10.1111/acps.12742] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. METHOD A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. RESULTS In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). CONCLUSION While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.
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Affiliation(s)
| | - L Aagaard
- Life Science Team, Bech-Bruun Law Firm, Copenhagen, Denmark
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, and Hospital Clínic, Department of Medicine, Barcelona University, and Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - L Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Cartabia
- Pharmacoepidemiology Unit, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - A Clavenna
- Pharmacoepidemiology Unit, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - A Coma Fusté
- Pharmacy Department of Barcelona Health Region, Catalan Health Service (CatSalut), Barcelona, Spain
| | - K Furu
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K Garuoliené
- Medicines Reimbursement Department, National Health Insurance Fund of the Republic of Lithuania, Vilnius, Lithuania.,Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Vilnius, Lithuania
| | - F Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - S Hollingworth
- School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia
| | - K F Huybrechts
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L J Kalverdijk
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands
| | - K Kawakami
- Department of Pharmacoepidemiology and Clinical Research Management, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - H Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T Kinoshita
- Department of Pharmacoepidemiology and Clinical Research Management, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - S C López
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira - Audifarma S.A., Pereira, Colombia
| | - J E Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira - Audifarma S.A., Pereira, Colombia
| | - M E Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira - Audifarma S.A., Pereira, Colombia
| | - M Mahesri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P S Nishtala
- New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - D Piovani
- Pharmacoepidemiology Unit, Department of Public Health, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - J Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L K Saastamoinen
- Kela Research, The Social Insurance Institution, Helsinki, Finland
| | - I Sato
- Department of Pharmacoepidemiology and Clinical Research Management, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - C C M Schuiling-Veninga
- Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Y-C Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Molecular Biology, Academia Sinica, Taipei, Qld, Taiwan.,Department of Nutrition, Chang Gung University of Science and Technology, Kwei-Shan, Taiwan
| | - D Siskind
- School of Medicine, University of Queensland, Woolloongabba, Qld, Australia
| | - S Skurtveit
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - H Verdoux
- University Bordeaux, INSERM, Bordeaux Population Health Research Center, team Pharmaco-epidemiology, UMR 1219, F-33000, Bordeaux, France
| | - L-J Wang
- Department of Child & Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C Zara Yahni
- Pharmacy Department of Barcelona Health Region, Catalan Health Service (CatSalut), Barcelona, Spain
| | - H Zoëga
- Bordeaux Population Health Research Center, INSERM, Univ. Bordeaux, team Pharmaco-epidemiology, UMR 1219, Bordeaux, France
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ramos Perdigués S, Sauras Quecuti R, Mané A, Mann L, Mundell C, Fernandez-Egea E. An observational study of clozapine induced sedation and its pharmacological management. Eur Neuropsychopharmacol 2016; 26:156-161. [PMID: 26613638 DOI: 10.1016/j.euroneuro.2015.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 11/29/2022]
Abstract
Clozapine induced sedation is common but its management is unclear. We analyzed the factors associated with clozapine-induced sedation and the efficacy of common pharmacological strategies. We conducted a naturalistic observational study using two years electronic records of a cohort patients and three analyses: a cross sectional analysis of factors associated with total number of hours slept (as an objective proxy of sedation), and two prospective analyses of which factors were associated with changes in hours slept and the efficacy of two pharmacological strategies. 133 patients were included, of which 64.7% slept at least 9h daily. Among monotherapy patients (n=30), only norclozapine levels (r=.367, p=.03) correlated with hours slept. Using the prospective cohort (n=107), 42 patients decreased the number of hours slept, due to decreasing clozapine (40%) or augmenting with aripiprazole (36%). These two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects respectively but the majority (81.8% and 73.9%) did not reduce number of hours slept. Thus, pharmacological and non-pharmacological factors are involved in sedation. Norclozapine plasma levels correlated with total sleeping hours. Reducing clozapine and aripiprazole augmentation were associated to amelioration of sedation, although both strategies were effective only in a limited numbers of subjects.
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Affiliation(s)
- Sònia Ramos Perdigués
- Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar and Fundacio IMIM, Barcelona, Spain
| | - Rosa Sauras Quecuti
- Centre de Salut Mental Horta, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Anna Mané
- Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar and Fundacio IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Louisa Mann
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Clare Mundell
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Emilio Fernandez-Egea
- Cambridgeshire and Peterborough NHS Foundation Trust, UK; Department of Psychiatry, Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, UK; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
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López-Muñoz F, Sanz-Fuentenebro J, Rubio G, García-García P, Álamo C. Quo Vadis Clozapine? A Bibliometric Study of 45 Years of Research in International Context. Int J Mol Sci 2015; 16:23012-34. [PMID: 26404263 PMCID: PMC4613349 DOI: 10.3390/ijms160923012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/04/2015] [Accepted: 09/13/2015] [Indexed: 12/26/2022] Open
Abstract
We have carried out a bibliometric study about the international scientific publications on clozapine. We have used the EMBASE and MEDLINE databases, and we applied bibliometric indicators of production, as Price's Law on the increase of scientific literature. We also calculated the participation index (PI) of the different countries. The bibliometric data have also been correlated with some social and health data from the 12 most productive countries in biomedicine and health sciences. In addition, 5607 original documents dealing with clozapine, published between 1970 and 2013, were downloaded. Our results state non-fulfilment of Price's Law, with scientific production on clozapine showing linear growth (r=0.8691, vs. r=0.8478 after exponential adjustment). Seven of the 12 journals with the highest numbers of publications on clozapine have an Impact Factor>2. Among the countries generating clozapine research, the most prominent is the USA (PI=24.32), followed by the UK (PI=6.27) and Germany (PI=5.40). The differences among countries on clozapine research are significantly related to economic variables linked to research. The scientific interest in clozapine remains remarkable, although after the application of bibliometric indicators of production, a saturation point is evident in the growth of scientific literature on this topic.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences and Chair of Genomic Medicine, Camilo José Cela University, C/Castillo de Alarcón, 49, Urb. Villafranca del Castillo, 28692 Villanueva de la Cañada, Madrid, Spain.
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
| | - Javier Sanz-Fuentenebro
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, 12 de Octubre University Hospital, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Biomedical Research Center Network for Mental Health (CIBERSAM), Madrid 28029, Spain.
| | - Gabriel Rubio
- Neuropsychopharmacology Unit, "Hospital 12 de Octubre" Research Institute, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, 12 de Octubre University Hospital, Avda. Córdoba, s/n, Madrid 28041, Spain.
- Department of Psychiatry, Complutense University, Plaza de Ramón y Cajal, s/n, Ciudad Universitaria, Madrid 28040, Spain.
- Networks for Cooperative Research in Health (RETICS-Addictive Disorder Network), Institute of Health Carlos III (ISCIII), MICINN and FEDER, Madrid 28029, Spain.
| | - Pilar García-García
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Campus Universitario-C/19, Ctra. Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
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Delayed initiation of clozapine may be related to poor response in treatment-resistant schizophrenia. Int Clin Psychopharmacol 2015; 30:290-5. [PMID: 26163875 DOI: 10.1097/yic.0000000000000086] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this retrospective chart-review study was to investigate the relationship between delayed commencement of clozapine and the level of response in treatment-resistant schizophrenia (TRS). We included 162 patients with schizophrenia who used clozapine. The mean delay until starting clozapine after fulfillment of the TRS criteria was 29 months. The delay was shorter in those who gained benefit from clozapine (P=0.04), those who were treated in a specialized psychosis outpatient unit (P=0.01), and in men (P=0.009), and it correlated with age (P<0.001). The delay in starting clozapine and the maximum clozapine dose were independent contributors toward the response to clozapine in the logistic regression analysis. Moreover, of those who gained considerable benefit from clozapine, the patients were younger (P=0.01), the duration of illness before clozapine treatment was shorter (P=0.001), and the numbers of adequate antipsychotic trials before the use of clozapine were fewer (P=0.05). Our findings suggest that efforts aimed at reducing the delay for starting clozapine may increase the effectiveness of clozapine in TRS.
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Concurrent Oral Antipsychotic Drug Use Among Schizophrenia Patients Initiated on Long-Acting Injectable Antipsychotics Post-Hospital Discharge. J Clin Psychopharmacol 2015; 35:442-6. [PMID: 26075492 DOI: 10.1097/jcp.0000000000000353] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pharmacological treatment is central to effective management of schizophrenia. Prescribing clinicians have an increasing array of options from which to choose, and oral antipsychotic polypharmacy is common in routine clinical practice. Practice guidelines recommend long-acting injectable (LAI) formulations, typically viewed as monotherapeutic alternatives, for patients with established nonadherence. Yet there are limited data on the prevalence and nature of concurrent oral antipsychotic prescriptions in patients receiving LAIs. Our observational, claims-based study examined the frequency and duration of concurrent oral prescriptions in 340 Medicaid patients receiving LAI therapy. Specifically, we examined patients with a recent history of nonadherence and hospitalization for schizophrenia and included both first-generation antipsychotic depot medications (fluphenazine decanoate, haloperidol decanoate) and more recently available second-generation injectables (LAI risperidone, paliperidone palmitate). Of all patients initiated on LAIs, 75.9% had a concurrent oral antipsychotic prescription in the 6 months post-hospital discharge. Patients receiving concurrent prescriptions were frequently prescribed an oral formulation of their LAI agent, but many first-generation LAI users received a concurrent second-generation oral medication. The lowest rate of concurrent prescribing (58.8%) was found with paliperidone palmitate, whereas the highest rate was with LAI risperidone (88.9%). Overlap in oral and LAI prescriptions typically occurred for a substantial period of time (ie, >30 days) and for a notable percentage of the days covered by LAIs (often 50% or more). Our findings highlight the need to further examine such prescribing patterns, to probe the reasons for them, and to clarify the optimal roles of different antipsychotic treatments in clinical practice.
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Hjorth P, Kilian R, Sørensen HØ, Eriksen SE, Davidsen AS, Jensen SOW, Munk-Jørgensen P. Reducing psychotropic pharmacotherapy in patients with severe mental illness: a cluster-randomized controlled intervention study. Ther Adv Psychopharmacol 2015; 5:67-75. [PMID: 26240746 PMCID: PMC4521442 DOI: 10.1177/2045125314565361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death. METHODS Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients' intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5. RESULTS The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5-18.1) (p = 0.028). DISCUSSION AND CONCLUSION We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.
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Affiliation(s)
- Peter Hjorth
- Aarhus University Hospital - Randers Lokal Psychiatry, Dronningborg Boulevard 15, Randers, 8900, Denmark
| | - Reinhold Kilian
- Klinik fur Psyckiatrie und Psychotherapie, Ulm University, Gunzburg, Germany
| | | | | | - Annette Sofie Davidsen
- Institut for folkevidenskab, Copenhagen University - Forskningsenheden for Almen Praksis og Afdelingen for Almen Medicin, Copenhagen, Denmark
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Grover S, Hazari N, Chakrabarti S, Avasthi A. Delay in initiation of clozapine: a retrospective study from a tertiary care hospital in North India. Psychiatry Res 2015; 226:181-5. [PMID: 25619433 DOI: 10.1016/j.psychres.2014.12.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023]
Abstract
This study aimed to assess the delay in initiation of clozapine, number of adequate antipsychotic trials prior to starting clozapine and practice of polypharmacy prior to starting clozapine. A retrospective study design was followed. Treatment records of 200 patients started on clozapine during the period of January 2006-June 2014 were reviewed. The mean delay in clozapine initiation was 1.93 (S.D. 1.82) years and median was 1.5 years. Mean of 3 (S.D. 1.18) adequate antipsychotic trials was given prior to considering clozapine and 27.5% patients had received polypharmacy prior to clozapine. Factors related to delay in starting of clozapine included higher age, longer duration of illness, age more than 20 years of age, polypharmacy, use of an adequate trial of typical antipsychotic medication, patients from urban locality and those with onset of illness prior to introduction of clozapine into Indian market. Findings of the present study suggest that there is a delay of 1.5-2 years in starting of clozapine and about one-fourth of patients receive polypharmacy prior to receiving clozapine. These finding suggests that there is a need to change the prescribing habits to reduce the delay in starting of clozapine.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Nandita Hazari
- Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Stanton RJ, Paxos C, Geldenhuys WJ, Pharm B, Boss JL, Munetz M, Darvesh AS, Pharm M. Clozapine underutilization in treatment-resistant schizophrenia. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.03.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
It has been shown that up to one third of patients with schizophrenia do not respond to antipsychotic therapy. Thus, treatment-resistant schizophrenia (TRS) remains a major mental health care challenge.
Clozapine has been shown to provide superior therapeutic benefits and is approved as first-line therapy for TRS. These benefits include improvement in both positive and negative symptoms, and reduction of suicidal behavior in patients with schizophrenia. Clozapine, however, remains significantly underused for TRS. A major reason for clozapine's underuse is its substantial adverse effect profile, mainly the risk of life-threatening agranulocytosis which necessitates regular hematologic monitoring. Another factor contributing to reduced clozapine prescribing is the increased use of other second-generation antipsychotics. In TRS patients, there is often a considerable delay in clozapine use, which is prescribed only after other unsuccessful second-generation antipsychotic trials. To combat this trend, there is a push for increased awareness to optimize clozapine prescribing. An important aspect in improving the use of clozapine therapy is physician and patient education. Furthermore, pharmacist involvement can improve clozapine prescription trends in TRS.
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Zhang S, Lan G. Prospective 8-week trial on the effect of olanzapine, quetiapine, and aripiprazole on blood glucose and lipids among individuals with first-onset schizophrenia. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 26:339-46. [PMID: 25642108 PMCID: PMC4311107 DOI: 10.11919/j.issn.1002-0829.214037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/08/2014] [Indexed: 11/22/2022]
Abstract
Background Metabolic symptoms induced by antipsychotic medication have been widely documented but there have been few studies comparing the effect of commonly used atypical antipsychotics on blood glucose and lipids among individuals with first-onset schizophrenia. Methods A total of 150 patients with first-onset schizophrenia were randomized into three groups and each group was treated with olanzapine, quetiapine, or aripiprazole for eight weeks. Blood glucose and lipids (including levels of triglyceride, total cholesterol, low-density lipoprotein, and high-density lipoprotein) were tested at baseline and at the end of the 8 weeks of treatment. Results Fasting blood glucose increased significantly over the 8 weeks in the olanzapine group but not in the quetiapine or aripiprazole groups. Based on a repeated measures analysis of variance, triglyceride levels increased significantly over the 8 weeks of treatment and high-density lipoprotein decreased significantly over the 8 weeks of treatment. The increase in triglyceride in the olanzapine and quetiapine groups was greater than that in the aripiprazole group, and the decrease in high-density lipoprotein was greater in the olanzapine and quetiapine groups than in the aripiprazole groups. Conclusions During the first 8 weeks of treatment of drug-naïve patients with schizophrenia, olanzapine has a greater effect on blood glucose than quetiapine or aripiprazole, and both olanzapine and quetiapine have a greater effect on blood lipids than aripiprazole.
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Affiliation(s)
- Shufen Zhang
- Kangle Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Guanghua Lan
- First affiliated Hospital of Suzhou University, Suzhou, Jiangsu Province, China
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Salomon C, Hamilton B, Elsom S. Experiencing antipsychotic discontinuation: results from a survey of Australian consumers. J Psychiatr Ment Health Nurs 2014; 21:917-23. [PMID: 25298092 DOI: 10.1111/jpm.12178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 12/19/2022]
Abstract
Despite high reported rates of antipsychotic non-adherence, little is known about consumer experiences during discontinuation. This study was designed to increase understanding of antipsychotic discontinuation from consumer perspectives. In 2011-2012, 98 Australian consumers involved with participating organizations completed an anonymous survey detailing past antipsychotic discontinuation attempts. Of the 88 participants who reported at least one discontinuation attempt, over half (n = 47, 54.7%) reported stopping without clinician knowledge or support. This group was 35% (confidence interval 15.4-54.6%) more likely to stop abruptly than those (n = 41, 45.3%) stopping with clinician support (P = 0.002). Only 10 participants (23.3%) recalled being given information about discontinuation symptoms other than relapse; however, 68 participants (78.2%) reported experiencing a range of discontinuation symptoms including physical, cognitive, emotional, psychotic or sleep-related disturbances. Findings cannot be readily generalized because of sampling constraints. However, the significant number of participants who reported discontinuation symptoms, in addition to psychosis, is consistent with previous research. This study provides new insight into consumer motivations for discontinuation and possible problems in clinical communication that may contribute to frequent non-collaborative discontinuation attempts. Mental health nurses, who play a pivotal role in medication communication events, may benefit from increased awareness of consumer perspectives on this topic.
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Affiliation(s)
- C Salomon
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Warnez S, Alessi-Severini S. Clozapine: a review of clinical practice guidelines and prescribing trends. BMC Psychiatry 2014; 14:102. [PMID: 24708834 PMCID: PMC3999500 DOI: 10.1186/1471-244x-14-102] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/31/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, despite the introduction of safer options. DISCUSSION Current clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have followed such recommendations. Clozapine is still underutilized especially in patients at risk of suicide. It seems that physicians are hesitant in prescribing clozapine due to concerns about serious adverse effects. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concerns about the underutilization of clozapine especially in patients at risk of suicide. SUMMARY Guidelines and prescribing patterns reported in various countries worldwide are discussed. Suggestions on how to optimize clozapine utilization have been published but more efforts are needed to properly inform and support prescribers' practices.
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Affiliation(s)
- Stephanie Warnez
- Faculty of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
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Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine. ISRN PSYCHIATRY 2014; 2014:904829. [PMID: 25006524 PMCID: PMC4003829 DOI: 10.1155/2014/904829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.
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Fe Bravo-Ortiz M, Gutiérrez-Casares JR, Rodríguez-Morales A, García MAP, Hidalgo-Borrajo R. Influence of type of treatment on the well-being of Spanish patients with schizophrenia and their caregivers. Int J Psychiatry Clin Pract 2011; 15:286-95. [PMID: 22122003 DOI: 10.3109/13651501.2011.608469] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to investigate quality of life and burden on caregivers in Spanish outpatients with schizophrenia, treated with different antipsychotics. METHODS Sociodemographic and clinical data were collected for 1865 patients diagnosed with schizophrenia. Patients answered the EuroQol-5D questionnaire and caregivers answered questionnaires assessing caregiver burden. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression of Severity (CGI-S), and clinician's satisfaction were also recorded. The same data were also collected at months 3 and 6. RESULTS According to EQ-5D results, usual activities (29.6%) and anxiety/depression (31.1%) were the most relevant reported problems. Good overall scores (5-7) on EQ-5D were reported by 47/118 (39.8%) of risperidone long-acting injectable (LAI) patients compared to 52/218 (23.9%) for oral conventional antipsychotics, 51/194 (26.2%) for injectable conventional antipsychotics, and 332/1110 (29.9%) for oral atypical antipsychotics. Significant benefits of risperidone LAI vs. other types of antipsychotic were also found in caregiver burden and clinician-derived outcome measures. At months 3 and 6, retention was > 85%, and score on the EQ5D improved for the overall sample. CONCLUSIONS In Spanish patients with schizophrenia, activities of daily living and anxiety/depression were more relevant reported problems. Risperidone LAI was associated with better quality-of-life outcomes and lower caregiver burden compared to other types of antipsychotic.
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Affiliation(s)
- María Fe Bravo-Ortiz
- Psychiatry Department, Hospital Universitario La Paz. Universidad Autonoma de Madrid, Spain.
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23
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Safety and efficacy of long-acting injectable risperidone in daily practice: an open-label, noninterventional, prospective study in schizophrenia and related disorders. Int Clin Psychopharmacol 2010; 25:149-54. [PMID: 20305567 DOI: 10.1097/yic.0b013e328336c93f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This postauthorization safety study evaluated the long-term safety, tolerability, and efficacy of risperidone long-acting injectable (RLAI) in routine clinical practice. In this 6-month, multicenter, European, naturalistic study, patients were included if, during routine clinical practice, long-term antipsychotic therapy with RLAI was deemed necessary by the treating physician. Efficacy measures included Clinical Global Impression-Severity and Global Assessment of Functioning. Safety was evaluated by recording treatment-emergent adverse events (AE). RLAI was initiated in 5134 patients (aged 14-94 years); predominantly male (58.6%) with paranoid schizophrenia (69.8%). RLAI initial doses were 25 mg every 2 weeks (37.0% patients), 37.5 mg (18.0%), and 50 mg (44.4%). Treatment was completed by 4314 patients (84.0%). RLAI was discontinued on account of loss to follow-up (n=346; 6.7%), insufficient response (n=116; 2.3%), and AEs (n=106; 2.1%). Clinical Global Impression-Severity significantly improved from baseline to endpoint (P<0.001). Patient functioning on the Global Assessment of Functioning scale also significantly improved from baseline to endpoint (45.4 + or - 16.0 vs. 62.4 + or - 17.7, respectively, P<0.001). Treatment-emergent AEs were recorded by 1018 (20%) of patients. AEs occurring in > or = 5% of patients were akathisia, extrapyramidal disorders, depression, psychotic disorder, anxiety, and weight gain. Serious AEs were reported by 384 (8%) patients. This study confirms good safety, tolerability, and efficacy with RLAI in routine clinical practice.
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Glazer WM, Byerly MJ. Tactics and technologies to manage nonadherence in patients with schizophrenia. Curr Psychiatry Rep 2008; 10:359-69. [PMID: 18627676 DOI: 10.1007/s11920-008-0057-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The occurrence of treatment nonadherence among patients with schizophrenia is clinically significant. However, studies show that clinicians do not make systematic efforts to identify and monitor it over time. This paper reviews the various tactics for identifying and monitoring adherence behavior. A comprehensive review of published studies comparing typical and atypical antipsychotics in terms of medication adherence yields mixed results at best. Changing forces in the delivery of health care in the United States will promote efforts to improve the recognition of nonadherence in patients with schizophrenia and develop strategies and tactics to decrease the current rates of nonadherence. Such tactics are described in this paper, and emerging best practices are identified. Ultimately, if nonadherence rates are to decrease, it will be necessary to align the incentives of the treater and the treated.
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Affiliation(s)
- William M Glazer
- Glazer Medical Solutions, 8 Nassau Lane, Key West, FL 33040, USA.
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Ce qu’il faut retenir sur les stratégies d’utilisation des antipsychotiques dans le traitement de la schizophrénie. ACTUALITES PHARMACEUTIQUES 2008. [DOI: 10.1016/s0515-3700(08)70215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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