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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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2
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Aissa A, Jouini R, Ouali U, Zgueb Y, Nacef F, El Hechmi Z. Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia. Compr Psychiatry 2022; 112:152280. [PMID: 34763293 DOI: 10.1016/j.comppsych.2021.152280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/16/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Treatment resistant schizophrenia (TRS), affecting approximately one-third of patients with schizophrenia, is associated with a serious impairment in global psychosocial functioning. Clozapine is the only licensed drug for TRS. However its prescription remains limited by its side effects requiring mandatory monitoring. The need to identify clinical factors associated with good response to clozapine in TRS has been established. The presence of ethnic differences in these factors and the scarcity of data on the Tunisian or more generally the North-African population warrants the conduct of a clinical study on the subject. The aim of this study was to investigate demographic, clinical, and biochemical patient characteristics as potential predictors of response to clozapine. METHODS This is a cross-sectional and retrospective study, at the "F and A psychiatry departments" of Razi Hospital in Manouba, Tunisia. All patients, with DSM 5 diagnosis of schizophrenia in its resistant form, on clozapine for at least 12 months and who consulted from June 1, 2018 to November 30, 2018 were included. We investigated premorbid functioning by the premorbid adjusment scale, demographic and clinical characteristics, and clozapine plasma level as potential clozapine response predictors. The response to clozapine was defined by a total BPRS score of 35 or less. RESULTS Sixty-three patients were included in the study. The mean age at clozapine introduction was 30,84 ±9,25 years. The mean duration of clozapine treatment was 7,22 ± 4,02 years. There were 16 clozapine responders (25%) who had BPRS total scores below or equal to 35 and 47 non-responders (75%). A higher premorbid social functioning in childhood (p = 0,018) and early adolescence (p = 0,024) was associated with better response to clozapine. A delay clozapine initiation shorter than 7 years(p = 0,036), one atypical antipsychotic trial (p = 0,029) and schizophrenia paranoid subtype (p< 0.01) were found to be significantly predictive of good clozapine response. None of the demographic factors or biochemical characteristics were associated with clozapine response. CONCLUSIONS Our work is consistent with previous studies suggesting the need for clinicians to be aware of the clinical predictors of a good response to clozapine to overcome their reluctance to prescribe it. It also highlighted the major prognostic role of premorbid adjustment in the clinical response to treatment. However, prospective studies including therapeutic drug monitoring would be very useful to better delineate the sub-group of patients to whom clozapine would benefit the most and to improve prescription modalities.
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Affiliation(s)
- Amina Aissa
- Razi Hospital, Mannouba, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.
| | - Rahma Jouini
- Psychiatry department, Centre Hospitalier Sud Francilien, Paris, France
| | - Uta Ouali
- Razi Hospital, Mannouba, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Yosra Zgueb
- Razi Hospital, Mannouba, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Fethi Nacef
- Razi Hospital, Mannouba, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
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3
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Gee S, Taylor D. COVID-19 infection causes a reduction in neutrophil counts in patients taking clozapine. J Psychiatry Neurosci 2021; 46:E232-E237. [PMID: 33703870 PMCID: PMC8061743 DOI: 10.1503/jpn.200208] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Monitoring of white cell counts during clozapine treatment leads to cessation of therapy if levels fall below predetermined values. Reductions in white cell counts, driven by lower levels of lymphocytes, have been observed with coronavirus disease 2019 (COVID-19). Neutropenia during COVID-19 has not been reported. We present data for 56 patients who were taking clozapine and had COVID-19. METHODS We included patients who were taking clozapine at the time they tested positive for COVID-19. We compared absolute neutrophil counts, lymphocyte counts and white cell counts between baseline and the first week of infection, and baseline and the second week of infection. RESULTS We observed reductions in absolute neutrophil counts (p = 0.005), lymphocyte counts (p = 0.003) and white cell counts (p < 0.001) between baseline and the first 7 days of COVID-19. All cell counts had returned to baseline levels by days 8 to 14. Six patients experienced neutropenia (absolute neutrophil counts < 2.0 × 109/L) and of those, 4 underwent mandatory cessation of clozapine. For 3 patients, clozapine treatment had been established for more than 6 months with no previous neutropenia, neutrophil levels returned to baseline within 2 weeks and no further neutropenia was observed on restarting treatment. LIMITATIONS This was a retrospective chart review; larger cohorts are required. Clozapine plasma levels were largely not measured by clinicians. CONCLUSION These data strongly suggest that mild neutropenia in the acute phase of COVID-19 in patients who are well established on clozapine is more likely to be a consequence of the virus than of clozapine treatment.
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Affiliation(s)
- Siobhan Gee
- From the Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom (Gee, Taylor); and the Institute of Pharmaceutical Sciences, King's College London, Franklin Wilkins Building, Stamford Street, London, United Kingdom (Gee, Taylor)
| | - David Taylor
- From the Pharmacy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom (Gee, Taylor); and the Institute of Pharmaceutical Sciences, King's College London, Franklin Wilkins Building, Stamford Street, London, United Kingdom (Gee, Taylor)
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4
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Griffiths K, Millgate E, Egerton A, MacCabe JH. Demographic and clinical variables associated with response to clozapine in schizophrenia: a systematic review and meta-analysis. Psychol Med 2021; 51:376-386. [PMID: 33602358 DOI: 10.1017/s0033291721000246] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia. However, response to clozapine is variable. Understanding the demographic and clinical features associated with response to clozapine may be useful for patient stratification for clinical trials or for identifying patients for earlier initiation of clozapine. We systematically reviewed the literature to investigate clinical and demographic factors associated with variation in clozapine response in treatment-resistant patients with schizophrenia spectrum disorders. Subsequently, we performed a random-effects meta-analysis to evaluate differences in duration of illness, age at clozapine initiation, age of illness onset, body weight and years of education between clozapine responders and non-responders. Thirty-one articles were eligible for qualitative review and 17 of these were quantitatively reviewed. Shorter duration of illness, later illness onset, younger age at clozapine initiation, fewer hospitalisations and fewer antipsychotic trials prior to clozapine initiation showed a trend to be significantly associated with a better response to clozapine. Meta-analysis of seven studies, totalling 313 subjects, found that clozapine responders had a significantly shorter duration of illness compared to clozapine non-responders [g = 0.31; 95% confidence interval (CI) 0.06-0.56; p = 0.01]. The results imply that a delay in clozapine treatment may result in a poorer response and that a focus on prompt treatment with clozapine is warranted.
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Affiliation(s)
- Kira Griffiths
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edward Millgate
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alice Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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5
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Jones R, MacCabe JH, Price MJ, Liu X, Upthegrove R. Effect of age on the relative efficacy of clozapine in schizophrenia. Acta Psychiatr Scand 2020; 142:109-120. [PMID: 31977065 DOI: 10.1111/acps.13156] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Early treatment of schizophrenia improves outcomes. Clozapine appears to have unique benefit when other antipsychotic medication has failed. This systematic review and meta-analysis aims to assess clozapine's superiority over alternative antipsychotic medication and examine whether earlier use is associated with additional benefit. METHOD Systematic retrieval of blinded, randomized controlled trials comparing clozapine with alternative antipsychotics in adults with schizophrenia. The effect of mean age on relative clozapine response was examined using random effects meta-regression, and multiple linear regression on available patient data. RESULTS A total of 276 studies were retrieved. Thirty-four studies were included in the meta-analysis. Clozapine was significantly more effective than alternative antipsychotics in reducing psychotic symptoms and increasing response. However, meta-regression failed to show a more significant effect in younger patients (age on effect size (total psychotic symptoms) 0.00, P = 0.79 CI -0.03 to 0.03). Individual patient data were available for two studies, the larger of which showed a significant interaction between younger age and superiority of clozapine. CONCLUSION The results support clozapine's superiority over other antipsychotics. A convincing effect of age on this effect was not demonstrated, although this was suggested in one study. In view of the age of many of the included studies, and changes in reporting practice over time, new clozapine RCTs, which include age of illness onset as well as age at trial time, would be welcome in order to provide meta-analysable data for future use.
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Affiliation(s)
- R Jones
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - J H MacCabe
- Department of Psychosis Studies, King's College London, and South London and Maudsley NHS Foundation Trust, London, UK
| | - M J Price
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - X Liu
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Affliated School of Medicine of South China University of Technology, Guangzhou, China
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS trust, Birmingham, UK
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6
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Costa MH, Kunz M, Nierenberg AA, Deckersbach T, Berk M, Magalhaes PVS. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:245-252. [PMID: 31958979 PMCID: PMC7385420 DOI: 10.1177/0706743719900460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The potential of clozapine in severe bipolar disorder is suggested by its
efficacy in refractory schizophrenia, but the evidence is limited thus far.
This report utilizes data from the standard care pathway of the Systematic
Treatment Enhancement Program to examine the clinical impact of clozapine in
bipolar disorder, comparing it to two groups, one that received olanzapine
and an additional group that received neither drug. Method: A total of 4,032 outpatients were available for this analysis. Groups for
longitudinal analyses are based on the medication used at each visit.
Outcomes assessed were clinical status, symptoms subscales,
hospitalizations, and death. We utilized mixed models and generalized
estimating equations to adjust for baseline differences and investigate
longitudinal differences in symptoms, clinical status, and hospitalization
rates between groups. Results: During the study, 1.1% (n = 43) of the patients used
clozapine at any time. Those on clozapine had significantly fewer manic and
depressive symptoms during follow-up as compared with those on neither
clozapine nor olanzapine, while those on olanzapine had more symptoms. The
use of clozapine was not associated with an increased risk of
hospitalization. No deaths were recorded for clozapine group during the
trial. Conclusions: Although prescribed to very few patients, the impact of clozapine was
notable, with fewer symptoms in patients who had more severe illnesses at
baseline. Clozapine could prove to be as successful an intervention for
late-stage bipolar disorder as it has been in schizophrenia.
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Affiliation(s)
- Marta H Costa
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauricio Kunz
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia.,Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia
| | - Pedro V S Magalhaes
- Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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The impact of clozapine initiation and cessation on psychiatric hospital admissions and bed days: a mirror image cohort study. Psychopharmacology (Berl) 2019; 236:1931-1935. [PMID: 30715572 DOI: 10.1007/s00213-019-5179-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clozapine is the most effective medication for the positive symptoms of treatment-refractory schizophrenia. Although clozapine use is associated with fewer admissions, less is known about the impact of clozapine cessation on hospitalisation. AIMS The aims of this study were to investigate whether clozapine-reduced psychiatric inpatient admissions and bed days, and investigate patient factors associated with these changes from a sample of 1906 people commenced on clozapine. METHODS All people commencing clozapine during an acute hospitalisation over a 10-year period in Queensland, Australia, were included in this retrospective cohort study. A mirror image design was used to compare psychiatric bed days and hospitalisations 2 years before and after clozapine treatment, and the impact of clozapine continuation or early cessation. Changes in psychiatric bed days and hospitalisations were analysed using linear regression, adjusting for the duration on clozapine, sex, age, indigenous status, country of origin and time to clozapine commencement. RESULTS/OUTCOMES There was a significant reduction in bed days (29.55 days vs 24.46 days, p < 0.001) and admissions (2.27 vs 1.87 < 0.001) associated with clozapine commencement. This remained significant among clozapine continuers, but not among those with early cessation. Longer duration on clozapine was associated with greater reductions in psychiatric bed days and admissions. Age, sex and time to clozapine commencement, indigeneity and country of origin did not impact outcomes. CONCLUSION/INTERPRETATION Longer clozapine therapy led to a greater reduction in psychiatric bed days and hospitalisations. Early cessation was associated with a return to pre-clozapine levels of bed days and admissions.
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Kesserwani J, Kadra G, Downs J, Shetty H, MacCabe JH, Taylor D, Stewart R, Chang CK, Hayes RD. Risk of readmission in patients with schizophrenia and schizoaffective disorder newly prescribed clozapine. J Psychopharmacol 2019; 33:449-458. [PMID: 30616489 PMCID: PMC6431783 DOI: 10.1177/0269881118817387] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Insight into the effect of clozapine is limited by a lack of controlling for confounding variables in current research. Our objective was to investigate the association between clozapine prescribed at discharge, following an inpatient episode, and risk of readmission into secondary mental health services in patients with schizophrenia and schizoaffective disorder, controlling extensively for confounding variables. METHODS Clinical records from 3651 patients were analysed in a retrospective observational cohort study. Cox proportional-hazards regression models were used to assess the risk of hospital readmission. A series of sensitivity analyses were also conducted. Propensity score methods were used to address confounding-by-indication. RESULTS Patients on clozapine ( n=202) had a reduced risk of readmission compared with patients on other antipsychotics (adjusted hazard ratio=0.79; 95% confidence interval: 0.64-0.99; p=0.043). Clozapine also had a protective effect on risk of readmission when compared with olanzapine (adjusted hazard ratio 0.76; 95% confidence interval: 0.60-0.96; p=0.021). The effect size remained consistent after adjusting for an array of possible confounders, as well as using propensity scores to address confounding-by-indication. A statistically significant result was also noted in all but two sensitivity analyses. CONCLUSION Our findings suggest that clozapine is associated with a reduced risk of readmission into secondary mental health services.
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Affiliation(s)
- Jad Kesserwani
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Giouliana Kadra
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, London, UK
| | - Johnny Downs
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Hitesh Shetty
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - James H MacCabe
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - David Taylor
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Robert Stewart
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Chin-Kuo Chang
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, London, UK
| | - Richard D Hayes
- King’s College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, London, UK
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9
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Abstract
OBJECTIVE Clozapine is uniquely effective for treatment-resistant schizophrenia, and so treatment continuation is essential. We aimed to identify factors associated with an increased likelihood of clozapine discontinuation in a cohort of patients in South East London. METHODS We gathered demographic and treatment information such as duration of illness and antipsychotic treatment history. t-tests, chi-square tests and binary logistic regression were used to compare patients who continued and discontinued clozapine during the study and to identify predictor variables for discontinuation. RESULTS Out of the study population of 133 patients, 48 discontinued clozapine at least once during the study period. The majority of these (75%) stopped treatment within the first 4 years of clozapine therapy. Age, ethnicity, diagnosis and antipsychotic treatment history were not predictive of the risk of clozapine discontinuation. However, male patients were more likely to stop taking clozapine (χ2 = 6.81, p = 0.009). The odds of discontinuing clozapine were 2.15 times higher for male patients. The most common reason for discontinuation was patient refusal of treatment. CONCLUSION We found that patients who discontinue clozapine are more likely to be male, but no other demographic variable was found to predict treatment cessation. Discontinuation usually occurred due to patient refusal of treatment.
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Affiliation(s)
- Siobhan H Gee
- 1 Pharmacy Department, South London and Maudsley NHS Foundation Trust, UK
| | | | - David M Taylor
- 3 Institute of Pharmaceutical Science, King's College London, UK
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10
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Kadra G, Stewart R, Shetty H, MacCabe JH, Chang CK, Kesserwani J, Taylor D, Hayes RD. Antipsychotic polypharmacy prescribing and risk of hospital readmission. Psychopharmacology (Berl) 2018; 235:281-289. [PMID: 29080904 PMCID: PMC5748404 DOI: 10.1007/s00213-017-4767-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/17/2017] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care. METHODS Using data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors. RESULTS We identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (n = 826) of patients were discharged on APP and 85% (n = 4697) on monotherapy. Of these, 30.9% (n = 255) and 23.4% (n = 1100) were readmitted respectively. Being discharged on APP was associated with a significantly increased risk of readmission, in comparison to patients discharged on monotherapy (HR = 1.4, 1.2-1.7, p < 0.001). This association was maintained in the fully adjusted model and following several sensitivity analyses. We further established that patients receiving clozapine APP (n = 200) were at a significantly increased risk for readmission in comparison to patients on clozapine monotherapy (HR = 1.8, 1.2-2.6, p = 0.008). CONCLUSIONS Our results suggest that patients discharged on APP are more likely to be readmitted into hospital within 6 months in comparison to those discharged on monotherapy. This needs to be considered in treatment decisions and the reasons for the association clarified.
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Affiliation(s)
- Giouliana Kadra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF, UK.
| | - Robert Stewart
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- 0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - James H. MacCabe
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
| | - Jad Kesserwani
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
| | - David Taylor
- 0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D. Hayes
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, BRC Neucleus, Mapother House, De Crespigny Park, London, SE5 8AF UK
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11
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Affiliation(s)
- David M Taylor
- Pharmacy Department, Maudsley Hospital, Denmark Hill, London, SE5 8AF, England, UK.
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12
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Lgaz H, Salghi R, Jodeh S, Hammouti B. Effect of clozapine on inhibition of mild steel corrosion in 1.0 M HCl medium. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2016.11.039] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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