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Cho JH, Mukherjee H, Sazhin V. Is antipsychotic augmentation associated with improved functioning in patients on clozapine? Australas Psychiatry 2024; 32:186-191. [PMID: 38330162 DOI: 10.1177/10398562241232819] [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] [Indexed: 02/10/2024]
Abstract
OBJECTIVE We aimed at exploring the relationship between functional outcomes in patients on clozapine augmented with antipsychotics in treatment-resistant schizophrenia using standard outcome measures Health of Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16). METHOD In a cross-sectional study of 83 patients on clozapine treated in a psychiatric rehabilitation hospital, the association between the primary outcome measure, LSP-16 including its subscales, and treatment with antipsychotic augmentation (AA) were analysed using linear regression. RESULT The presence of moderate-to-severe positive symptoms on the HoNOS 6 dichotomised item measure was the only statistically significant predictor of functional impairment as determined by total LSP-16 score.The group of patients with ongoing positive symptoms (partial responders) were characterised by higher total LSP-16 scores, higher numbers of AA agents, and higher chlorpromazine equivalence. There was an inverse linear relationship between chlorpromazine equivalence of AA and total score of LSP-16 scale in the group of partial responders. CONCLUSION Augmentation with other antipsychotic agents was associated with higher functioning in a cross-sectional study of patients with schizophrenia with poor response of positive symptoms to clozapine. This might be an important clinical factor to consider when prescribing antipsychotics to patients with clozapine-resistant schizophrenia.
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Affiliation(s)
- Jae Hee Cho
- Macquarie Hospital (Northern Sydney Local Health District), St Leonards, NSW, Australia
| | | | - Vladimir Sazhin
- Macquarie Hospital (Northern Sydney Local Health District), St Leonards, NSW, Australia
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Oloyede E, Dima A, Taylor D, Cheung H, Dzahini O, Shergill S, Whiskey E. Clozapine augmentation with long-acting antipsychotic injections: A case series and systematic review. Acta Psychiatr Scand 2023; 148:538-552. [PMID: 37899506 DOI: 10.1111/acps.13621] [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: 07/11/2023] [Revised: 08/17/2023] [Accepted: 09/24/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Up to 30% of patients with a diagnosis of treatment-resistant psychosis remain symptomatic despite an optimal trial with the gold standard treatment, clozapine. Emerging evidence suggests the clinical utility of long-acting injections (LAI) in such clinical scenarios. In this study, we aimed to describe clozapine augmentation with LAIs in an inner London hospital and explore the literature on the clinical effectiveness of this treatment modality. METHODS Patients prescribed clozapine, who were commenced on a LAI between 2007 and 2023 by the United Kingdom's largest mental health trust, were identified from electronic patient records. First, routine clinical data were used to describe the use, effectiveness, and safety of this augmentation strategy. Second, we conducted a literature search up to 1st June 2023 to identify published studies describing clinical outcomes after clozapine augmentation with a LAI. Clinical outcomes were collated and presented in a table, including hospitalisation rates and quantitative clinical assessments using validated scales. RESULTS Of the 1248 patients prescribed clozapine in SLaM, three patients (0.2%) received augmentation with the following LAIs: olanzapine embonate, paliperidone palmitate and pipotiazine palmitate. This treatment strategy was clinically effective and generally well tolerated in all three cases. Twelve published studies between 2010 and 2022 were included in the review. Eight distinct LAIs were reported (4 first and 4 second generation antipsychotics), with risperidone and paliperidone most widely studied. All the identified studies were observational including mirror-image studies, case series and case reports. Duration of follow up varied from 3 months to 3 years. There was evidence that the use of LAIs with clozapine can significantly reduce clinical symptoms, hospitalisation rates and bed days. No serious adverse effects were reported. CONCLUSION This preliminary evidence suggests clinical utility of LAIs in alleviating residual symptoms and subsequently reducing hospitalisation rates in patients optimised on clozapine treatment. The current study warrants further investigations including a randomised controlled study to establish the clinical efficacy, tolerability, and place in therapy of this treatment modality.
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Affiliation(s)
- Ebenezer Oloyede
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Aikaterini Dima
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Taylor
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Henry Cheung
- Pharmacy Department, South West London and St George's Mental Health NHS Trust, London, UK
| | - Olubanke Dzahini
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Sukhi Shergill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Medical School, Kent and Medway NHS and Social Care Partnership Trust, Chatham, UK
| | - Eromona Whiskey
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
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de Bartolomeis A, Ciccarelli M, Vellucci L, Fornaro M, Iasevoli F, Barone A. Update on novel antipsychotics and pharmacological strategies for treatment resistant schizophrenia. Expert Opin Pharmacother 2022; 23:2035-2052. [DOI: 10.1080/14656566.2022.2145884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Mariateresa Ciccarelli
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Licia Vellucci
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Michele Fornaro
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Annarita Barone
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
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Fonseca de Freitas D, Agbedjro D, Kadra-Scalzo G, Francis E, Ridler I, Pritchard M, Shetty H, Segev A, Casetta C, Smart SE, Morris A, Downs J, Christensen SR, Bak N, Kinon BJ, Stahl D, Hayes RD, MacCabe JH. Clinical correlates of early onset antipsychotic treatment resistance. J Psychopharmacol 2022; 36:1226-1233. [PMID: 36268751 PMCID: PMC9643817 DOI: 10.1177/02698811221132537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is evidence of heterogeneity within treatment-resistant schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and others becoming treatment-resistant after an initial response period. These groups may have different aetiologies. AIM This study investigates sociodemographic and clinical correlates of early onset of TRS. METHOD Employing a retrospective cohort design, we do a secondary analysis of data from a cohort of people with TRS attending the South London and Maudsley. Regression analyses were conducted to identify the correlates of the length of treatment to TRS. Predictors included the following: gender, age, ethnicity, problems with positive symptoms, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics. RESULTS In a cohort of 164 people with TRS (60% were men), the median length of treatment to TRS was 3 years and 8 months. We observed no cut-off on the length of treatment until TRS presentation differentiating between early and late TRS (i.e. no bimodal distribution). Having mild to very severe problems with hallucinations and delusions at the treatment start was associated with earlier TRS (~19 months earlier). In sensitivity analyses, including only complete cases (subject to selection bias), treatment with a long-acting injectable antipsychotic was additionally associated with later TRS (~15 months later). CONCLUSION Our findings do not support a clear separation between early and late TRS but rather a continuum of the length of treatment before TRS onset. Having mild to very severe problems with positive symptoms at treatment start predicts earlier onset of TRS.
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Affiliation(s)
- Daniela Fonseca de Freitas
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- Department of Psychiatry, University of
Oxford, Oxford, UK
| | - Deborah Agbedjro
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | | | - Emma Francis
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- Division of Psychology and Language
Sciences, University College London, London, UK
| | - Isobel Ridler
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | - Megan Pritchard
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS
Foundation Trust, London, UK
- Norwich Medical School, University of
East Anglia, Norwich, UK
| | - Hitesh Shetty
- South London and Maudsley NHS
Foundation Trust, London, UK
| | - Aviv Segev
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
- Shalvata Mental Health Center, Hod
Hasharon, Israel
| | - Cecilia Casetta
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- Department of Health Sciences,
Università degli Studi di Milano, Milan, Italy
| | - Sophie E. Smart
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- MRC Centre for Neuropsychiatric
Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Anna Morris
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | - Johnny Downs
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Bruce J. Kinon
- Lundbeck Pharmaceuticals LLC,
Deerfield, IL, USA
- Cyclerion Therapeutics, Cambridge,
MA, USA
| | - Daniel Stahl
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | - Richard D. Hayes
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
| | - James H. MacCabe
- Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS
Foundation Trust, London, UK
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