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Oliver D, Arribas M, Perry BI, Whiting D, Blackman G, Krakowski K, Seyedsalehi A, Osimo EF, Griffiths SL, Stahl D, Cipriani A, Fazel S, Fusar-Poli P, McGuire P. Using Electronic Health Records to Facilitate Precision Psychiatry. Biol Psychiatry 2024; 96:532-542. [PMID: 38408535 DOI: 10.1016/j.biopsych.2024.02.1006] [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: 10/16/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
The use of clinical prediction models to produce individualized risk estimates can facilitate the implementation of precision psychiatry. As a source of data from large, clinically representative patient samples, electronic health records (EHRs) provide a platform to develop and validate clinical prediction models, as well as potentially implement them in routine clinical care. The current review describes promising use cases for the application of precision psychiatry to EHR data and considers their performance in terms of discrimination (ability to separate individuals with and without the outcome) and calibration (extent to which predicted risk estimates correspond to observed outcomes), as well as their potential clinical utility (weighing benefits and costs associated with the model compared to different approaches across different assumptions of the number needed to test). We review 4 externally validated clinical prediction models designed to predict psychosis onset, psychotic relapse, cardiometabolic morbidity, and suicide risk. We then discuss the prospects for clinically implementing these models and the potential added value of integrating data from evidence syntheses, standardized psychometric assessments, and biological data into EHRs. Clinical prediction models can utilize routinely collected EHR data in an innovative way, representing a unique opportunity to inform real-world clinical decision making. Combining data from other sources (e.g., meta-analyses) or enhancing EHR data with information from research studies (clinical and biomarker data) may enhance our abilities to improve the performance of clinical prediction models.
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Affiliation(s)
- Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Maite Arribas
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Benjamin I Perry
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Whiting
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Graham Blackman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Kamil Krakowski
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Aida Seyedsalehi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Emanuele F Osimo
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; Imperial College London Institute of Clinical Sciences and UK Research and Innovation MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, London, United Kingdom; South London and the Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Andrea Cipriani
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; South London and the Maudsley National Health Service Foundation Trust, London, United Kingdom; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Poletti M, Pelizza L, Preti A, Raballo A. Clinical High-Risk for Psychosis (CHR-P) circa 2024: Synoptic analysis and synthesis of contemporary treatment guidelines. Asian J Psychiatr 2024; 100:104142. [PMID: 39083954 DOI: 10.1016/j.ajp.2024.104142] [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: 04/11/2024] [Revised: 06/05/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024]
Abstract
The construct of Clinical-High Risk for Psychosis (CHR-P) identifies young help-seeking subjects in putative prodromal stages of psychosis and is a central component of the Early Intervention (EI) paradigm in Mental Health, aimed at facilitating rapid entry into appropriate care pathways to prevent the onset of psychosis or mitigate is biopsychosocial consequences. This approach, which promotes an innovative culture of care for early, at risk situations, is inspired by a clinical staging concept as a guide to optimal treatment. The objective of this article is to map the existing guidelines in the field of CHR-P treatment recommendations, examine overlaps and differences, and critically evaluate blind spots to be addressed in future guideline updated. The search identified 9 guidelines focused on CHR-P or schizophrenia and other psychotic conditions but containing a specific section on CHR-P or prodromal psychosis. All guidelines acknowledge that psychosis is preceded by more or less pronounced prodromal stages, and most detail CHR-P criteria. Among guidelines, 8 out of 9 indicate cognitive-behavioural therapy as the best psychotherapeutic option and 7 out of 9 suggest that antipsychotics can be prescribed as second option in case psychosocial and/or other pharmacological interventions prove insufficient or inadequate in reducing clinical severity and subjective suffering. Antidepressants, mood stabilizers, and benzodiazepines were considered for the treatment of comorbid disorders. Only the European Psychiatric Association Guidance paper distinguished treatment recommendations for adults and minors. Agreements in treatment guidelines were discussed in light of recent meta-analytical evidences on pharmacological and non-pharmacological treatments for CHR-P, suggesting the need to provide an updated, age-sensitive consensus on how to manage CHR-P individuals.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Università di Bologna, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland; Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland.
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Lagreula J, Dagenais-Beaulé V, de Timary P, Elens L, Dalleur O. Prescribing and deprescribing trends in schizophrenia: An overview of inpatients in Belgium and in the Canadian province of Québec. Basic Clin Pharmacol Toxicol 2023; 133:691-702. [PMID: 36988426 DOI: 10.1111/bcpt.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
Although switching to antipsychotic monotherapy improves patient outcomes in schizophrenia, antipsychotic deprescribing is rarely performed, and its use varies between countries, as do psychotropic prescribing patterns. This study aimed to determine factors associated with antipsychotic deprescribing at discharge after a psychiatric hospitalization and to compare psychotropic prescribing patterns between Belgium and Québec, Canada. Data on adult inpatients with schizophrenia were collected retrospectively in seven hospitals. At discharge, the number of antipsychotics had decreased in 22.2% of the 63 Canadian patients and 9.9% of the 516 Belgian patients. A number of factors increased the likelihood of antipsychotic deprescribing: a hospitalization in the Canadian hospital (aOR = 4.13, 95% CI 1.48-11.5), living in a residential facility (aOR = 2.51, 95% CI 1.05-4.39), ≥2 previous antipsychotic trials (aOR = 15.38, 95% CI 3.62-65.36), having an antipsychotic side effect (aOR = 1.86, 95% CI 1.01-3.44) and being in a general hospital (aOR = 2.28, 95% CI 1.09-4.75). Patients on a long-acting injectable antipsychotic (aOR = 0.51, 95% CI 0.26-0.98), with prior clozapine use (aOR = 0.36, 95% CI 0.13-0.95), greater antipsychotic exposure (aOR = 0.35, 95% CI 0.2-0.61) and more hypno-sedatives (aOR = 0.65, 95% CI 0.43-0.98), were less likely to be deprescribed. Specific deprescribing interventions could target patients who are less likely to be deprescribed.
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Affiliation(s)
- Juliette Lagreula
- Clinical Pharmacy Research Group (CLIP)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Fonds de la Recherche Scientifique - FNRS, Brussels, Belgium
| | - Vincent Dagenais-Beaulé
- Pharmacy Department & Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
| | - Philippe de Timary
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium
- Adult Psychiatry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics (PMGK)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Louvain Center for Toxicology and Applied Pharmacology (LTAP)-Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Ito S, Ohi K, Yasuda Y, Fujimoto M, Yamamori H, Matsumoto J, Fukumoto K, Kodaka F, Hasegawa N, Ishimaru K, Miura K, Yasui-Furukori N, Hashimoto R. Better adherence to guidelines among psychiatrists providing pharmacological therapy is associated with longer work hours in patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:78. [PMID: 37935686 PMCID: PMC10630392 DOI: 10.1038/s41537-023-00407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
Schizophrenia is a psychiatric disorder that is associated with various social dysfunctions, including shorter work hours. To measure the degree to which psychiatrists adhere to guidelines for pharmacological therapy of schizophrenia, we recently developed the individual fitness score (IFS) for adherence among psychiatrists in each patient. However, it remains unclear whether better adherence among psychiatrists is associated with higher patients' social functional outcomes, such as work hours. In this study, we examined the relationship between adherence to guidelines among psychiatrists and work hours in patients with schizophrenia. To evaluate the association between adherence to guidelines for pharmacological therapy among psychiatrists for treating schizophrenia and work hours, we used the IFS and social activity assessment, respectively, in 286 patients with schizophrenia. The correlation between IFS values and work hours was investigated in the patients. The adherence among psychiatrists to guidelines was significantly and positively correlated with work hours in patients with schizophrenia (rho = 0.18, p = 2.15 × 10-3). When we divided the patients into treatment-resistant schizophrenia (TRS) and nontreatment-resistant schizophrenia (non-TRS) groups, most patients with TRS (n = 40) had shorter work hours (0-15 h/week). Even after excluding patients with TRS, the positive correlation between adherence to guidelines among psychiatrists and work hours in patients with non-TRS (n = 246) was still significant (rho = 0.19, p = 3.32 × 10-3). We found that work hours were longer in patients who received the guideline-recommended pharmacotherapy. Our findings suggest that widespread education and training for psychiatrists may be necessary to improve functional outcomes in patients with schizophrenia.
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Affiliation(s)
- Satsuki Ito
- Department of Developmental and Clinical Psychology, The Division of Human Developmental Sciences, Graduate School of Humanity and Sciences, Ochanomizu University, Tokyo, Japan
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
- Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Fumitoshi Kodaka
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Kodaka F, Ohi K, Yasuda Y, Fujimoto M, Yamamori H, Hasegawa N, Ito S, Fukumoto K, Matsumoto J, Miura K, Yasui-Furukori N, Hashimoto R. Relationships Between Adherence to Guideline Recommendations for Pharmacological Therapy Among Clinicians and Psychotic Symptoms in Patients With Schizophrenia. Int J Neuropsychopharmacol 2023; 26:557-565. [PMID: 37381793 PMCID: PMC10464927 DOI: 10.1093/ijnp/pyad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/28/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Clinician adherence to guideline recommendations in the pharmacological therapy of schizophrenia is important for favorable patient outcomes. To evaluate whether prescriptions followed the guidelines for pharmacological therapy of schizophrenia, we recently developed a summary indicator of multiple quality indicators: the individual fitness score (IFS). It is unclear whether adherence to the guidelines is related to patient outcomes. Here, we investigated correlations between the IFS values and psychotic symptoms in patients with schizophrenia. METHODS We assessed whether patients' current prescriptions adhered to the guideline recommendations using the IFS in 47 patients with treatment-resistant schizophrenia (TRS) and 353 patients with non-TRS (total n = 400), respectively. We investigated correlations between the IFS and total scores and scores on the 5 subscales of the Positive and Negative Syndrome Scale (PANSS). Furthermore, we explored correlations between over 2-year longitudinal changes in IFS values and changes in psychotic symptoms in some patients (n = 77). RESULTS We found significant negative correlation between the IFS and PANSS total score in all patients with schizophrenia (β = -0.18, P = 9.80 × 10-5). The IFS was significantly and nominally negatively correlated with the PANSS total score in patients with non-TRS (Spearman's rho = -0.15, P = 4.40 × 10-3) and patients with TRS (rho = -0.37, P = .011), respectively. The IFS was also significantly and nominally negatively correlated with several factors, such as the negative and depressed factors, in patients with non-TRS and patients with TRS, respectively (P < .05). Furthermore, the change in IFS values was marginally negatively correlated with the changes in PANSS total scores and scores on the positive and depressed factors (P < .05). CONCLUSIONS These findings suggest that efforts to improve clinician adherence to guideline recommendations for pharmacological therapy of schizophrenia, as assessed by the IFS, may lead to better outcomes in patients with schizophrenia.
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Affiliation(s)
- Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
- Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Satsuki Ito
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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Eckardt JP. Family caregivers: never underestimate the power of hope. Nord J Psychiatry 2023; 77:624-626. [PMID: 36803377 DOI: 10.1080/08039488.2023.2178672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
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Chopra AS, Hadzi Boskovic D, Kulkarni A, Cochran JM. Cost-Effectiveness of Aripiprazole Tablets with Sensor versus Oral Atypical Antipsychotics for the Treatment of Schizophrenia Using a Patient-Level Microsimulation Modeling Approach. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:375-386. [PMID: 37252199 PMCID: PMC10218468 DOI: 10.2147/ceor.s396806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Strategies designed to track drug ingestion may improve medication adherence and clinical outcomes in adults with schizophrenia. This study aimed to estimate the cost-effectiveness of aripiprazole tablets with sensor (AS; Abilify MyCite®) versus generic oral atypical antipsychotics (AAPs) in schizophrenia from the United States payer and societal perspectives over 12 months. Methods An individual-level microsimulation was developed to generate individual trajectories using data from a phase 3b multicenter, open-label, mirror-image trial in adults with schizophrenia treated prospectively for 6 months with AS. The patient's clinical characteristics and outcomes were computed as a function of the Positive and Negative Syndrome Scale (PANSS) scores. Direct and indirect medical cost estimates were sourced from the literature; EuroQol 5-Dimensions (EQ-5D) utilities were derived using risk equations based on patient and clinical characteristics. Scenario analyses were also conducted to assess outcomes under the assumption of treatment durability over 12 months. Results Over 12 months, AS showed a 12.2% improvement in PANSS score. AS had an incremental cost of $2168 and incremental cost savings of $22,343 from the payer and societal perspectives, respectively, with an incremental quality-adjusted life-year (QALY) gain of 0.0298 versus oral AAPs. Further, AS resulted in a 28.2% reduction in hospitalizations over 12 months. At a willingness-to-pay of $100,000 per QALY, the net monetary benefit over 12 months was $25,323 from the payer perspective. Under the assumption of the durability of the treatment effect of AS, the findings were similar to those of the base case analyses, though with greater cost savings and QALYs gained with AS. The results from the sensitivity analyses were consistent with those of the base case analysis. Conclusion AS may be a cost-effective strategy, with lower costs and improved quality of life among patients with schizophrenia over 12 months, from the payer and societal perspectives.
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Affiliation(s)
| | | | - Amit Kulkarni
- Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ, USA
| | - Jeffrey M Cochran
- Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ, USA
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8
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Okhuijsen-Pfeifer C, van der Horst MZ, Bousman CA, Lin B, van Eijk KR, Ripke S, Ayhan Y, Babaoglu MO, Bak M, Alink W, van Beek H, Beld E, Bouhuis A, Edlinger M, Erdogan IM, Ertuğrul A, Yoca G, Everall IP, Görlitz T, Grootens KP, Gutwinski S, Hallikainen T, Jeger-Land E, de Koning M, Lähteenvuo M, Legge SE, Leucht S, Morgenroth C, Müderrisoğlu A, Narang A, Pantelis C, Pardiñas AF, Oviedo-Salcedo T, Schneider-Thoma J, Schreiter S, Repo-Tiihonen E, Tuppurainen H, Veereschild M, Veerman S, de Vos M, Wagner E, Cohen D, Bogers JPAM, Walters JTR, Yağcıoğlu AEA, Tiihonen J, Hasan A, Luykx JJ. Genome-wide association analyses of symptom severity among clozapine-treated patients with schizophrenia spectrum disorders. Transl Psychiatry 2022; 12:145. [PMID: 35393395 PMCID: PMC8989876 DOI: 10.1038/s41398-022-01884-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 12/26/2022] Open
Abstract
Clozapine is the most effective antipsychotic for patients with treatment-resistant schizophrenia. However, response is highly variable and possible genetic underpinnings of this variability remain unknown. Here, we performed polygenic risk score (PRS) analyses to estimate the amount of variance in symptom severity among clozapine-treated patients explained by PRSs (R2) and examined the association between symptom severity and genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activity. Genome-wide association (GWA) analyses were performed to explore loci associated with symptom severity. A multicenter cohort of 804 patients (after quality control N = 684) with schizophrenia spectrum disorder treated with clozapine were cross-sectionally assessed using the Positive and Negative Syndrome Scale and/or the Clinical Global Impression-Severity (CGI-S) scale. GWA and PRS regression analyses were conducted. Genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activities were calculated. Schizophrenia-PRS was most significantly and positively associated with low symptom severity (p = 1.03 × 10-3; R2 = 1.85). Cross-disorder-PRS was also positively associated with lower CGI-S score (p = 0.01; R2 = 0.81). Compared to the lowest tertile, patients in the highest schizophrenia-PRS tertile had 1.94 times (p = 6.84×10-4) increased probability of low symptom severity. Higher genotype-predicted CYP2C19 enzyme activity was independently associated with lower symptom severity (p = 8.44×10-3). While no locus surpassed the genome-wide significance threshold, rs1923778 within NFIB showed a suggestive association (p = 3.78×10-7) with symptom severity. We show that high schizophrenia-PRS and genotype-predicted CYP2C19 enzyme activity are independently associated with lower symptom severity among individuals treated with clozapine. Our findings open avenues for future pharmacogenomic projects investigating the potential of PRS and genotype-predicted CYP-activity in schizophrenia.
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Affiliation(s)
- C Okhuijsen-Pfeifer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
| | - M Z van der Horst
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
- GGNet Mental Health, Warnsveld, The Netherlands
| | - C A Bousman
- Department of Medical Genetics, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Physiology & Pharmacology, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Melbourne, Melbourne Neuropsychiatry Centre, Melbourne, Australia
| | - B Lin
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
| | - K R van Eijk
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
| | - S Ripke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Y Ayhan
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - M O Babaoglu
- Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - M Bak
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Mental Health Institute, Maastricht, The Netherlands
| | - W Alink
- Multicomplexe Zorg, Pro Persona, Wolfheze, The Netherlands
| | - H van Beek
- Clinical Recovery Clinic, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | - E Beld
- Mental Health Organization North-Holland North location Den Helder, Den Helder, The Netherlands
| | - A Bouhuis
- Program for early psychosis & severe mental illness, Pro Persona Mental Healthcare, Wolfheze, The Netherlands
| | - M Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division for Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - I M Erdogan
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - A Ertuğrul
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - G Yoca
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Şarkışla State Hospital, Ministry of Health, Sivas, Turkey
| | - I P Everall
- Department of Psychiatry, University of Melbourne, Melbourne Neuropsychiatry Centre, Melbourne, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - T Görlitz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - K P Grootens
- Reinier van Arkel, s-Hertogenbosch, The Netherlands
- Unit for Clinical Psychopharmacology and Neuropsychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Gutwinski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - T Hallikainen
- Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland
| | - E Jeger-Land
- Arkin, Institute for Mental Health, Amsterdam, The Netherlands
| | - M de Koning
- Arkin, Institute for Mental Health, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - M Lähteenvuo
- Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland
| | - S E Legge
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - S Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Morgenroth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - A Müderrisoğlu
- Department of Pharmacology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - A Narang
- Department of Medical Genetics, University of Calgary, Calgary, Canada
| | - C Pantelis
- Department of Psychiatry, University of Melbourne, Melbourne Neuropsychiatry Centre, Melbourne, Australia
| | - A F Pardiñas
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - T Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - S Schreiter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - E Repo-Tiihonen
- Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland
| | - H Tuppurainen
- Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland
| | | | - S Veerman
- Mental Health Organization North-Holland North location Alkmaar, Alkmaar, The Netherlands
| | - M de Vos
- GGNet Mental Health, Warnsveld, The Netherlands
| | - E Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - D Cohen
- Mental Health Organization North-Holland North location Heerhugowaard, Heerhugowaard, The Netherlands
| | - J P A M Bogers
- High Care Clinics, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | - J T R Walters
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - A E Anil Yağcıoğlu
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - J Tiihonen
- Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Center for Psychiatric Research, Stockholm City Council, Stockholm, Sweden
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - J J Luykx
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands.
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands.
- GGNet Mental Health, Warnsveld, The Netherlands.
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9
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Lagreula J, de Timary P, Elens L, Dalleur O. Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation. Ther Adv Psychopharmacol 2022; 12:20451253221112587. [PMID: 36051501 PMCID: PMC9425880 DOI: 10.1177/20451253221112587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy. OBJECTIVES To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns. DESIGN We performed a retrospective observational study based on electronic health records. METHODS Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021. RESULTS Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (ORadmission = 2.53, CI = 1.1-5.84, ORdischarge = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (ORadmission = 26.79, CI = 13.08-54.86, ORdischarge = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (ORadmission = 8.93, CI = 5.13-15.56, ORdischarge = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (ORadmission = 1.88, CI = 1.23-2.88, ORdischarge = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (ORadmission = 0.31, CI = 0.14-0.7, ORdischarge = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (ORadmission = 0.26, CI = 0.13-0.54) and higher age (ORdischarge = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (ORdischarge = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (ORdischarge = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy. CONCLUSION Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.
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Affiliation(s)
- Juliette Lagreula
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Avenue Mounier 72, 1200 Brussels, Belgium.,Fonds de la Recherche Scientifique (FNRS), Brussels, Belgium
| | - Philippe de Timary
- Institute of Neuroscience, UCLouvain, Brussels, Belgium.,Psychiatry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics (PMGK), Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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