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De Las Cuevas C, Sanz EJ, Gross JA, Correll CU, Verdoux H, Lally J, de Filippis R, Schulte PFJ, Molden E, Arrojo-Romero M, Bostrom AD, Schoretsanitis G, Fernandez-Egea E, de Leon J. Revealing the reporting disparity: VigiBase highlights underreporting of clozapine in other Western European countries compared to the UK. Schizophr Res 2024; 268:175-188. [PMID: 38065799 DOI: 10.1016/j.schres.2023.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 06/15/2024]
Abstract
BACKGROUND Pharmacovigilance studies indicate clozapine history is marked by adverse drug reactions (ADRs). OBJECTIVE In a 2021 article, the United Kingdom (UK) had >90 % of European clozapine-related fatal outcomes in VigiBase, the World Health Organization's pharmacovigilance database. Two possibly opposing hypotheses could explain this disparity: 1) fewer reported fatal outcomes in other Western European countries mainly reflect underreporting to VigiBase, and 2) the higher number of UK reports reflects higher real relative mortality. METHODS VigiBase reports from clozapine's introduction to December 31, 2022, were studied for ADRs and the top 10 causes of fatal outcomes. The UK was compared with 11 other top reporting Western countries (Germany, Denmark, France, Finland, Ireland, Italy, Netherlands, Norway, Spain, Sweden and Switzerland). Nine countries (except Ireland and Switzerland) were compared after controlling for population and clozapine prescriptions. RESULTS The UK accounted for 29 % of worldwide clozapine-related fatal outcomes, Germany 2 % and <1 % in each of the other countries. The nonspecific label "death" was the top cause in the world (46 %) and in the UK (33 %). "Pneumonia" was second in the world (8 %), the UK (12 %), Ireland (8 %) and Finland (14 %). Assuming that our corrections for population and clozapine use are correct, other countries underreported only 1-10 % of the UK clozapine fatal outcome number. CONCLUSIONS Different Western European countries consistently underreport to VigiBase compared to the UK, but have different reporting/publishing styles for clozapine-related ADRs/fatal outcomes. Three Scandinavian registries suggest lives are saved as clozapine use increases, but this cannot be studied in pharmacovigilance databases.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain; Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain.
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain; Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA.
| | - Hélène Verdoux
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France.
| | - John Lally
- Department of Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Peter F J Schulte
- Mental Health Services Noord-Holland-Noord, Alkmaar, the Netherlands; Dutch Clozapine Collaboration Group, Castricum, the Netherlands.
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Manuel Arrojo-Romero
- Department of Psychiatry, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
| | - Adrian D Bostrom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK,; Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK.
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain.
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Berger SJ, Hofer A. [Safety aspects during treatment with clozapine: : Adverse effects, titration, and therapeutic drug monitoring - a narrative review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:122-129. [PMID: 37349671 PMCID: PMC10491532 DOI: 10.1007/s40211-023-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND According to current guidelines, clozapine should be used as a third step in treatment resistant schizophrenia (TRS). In everyday clinical practice, however, it is frequently used at a much later stage, which leads to a significant deterioration of prognosis. The first part of this narrative overview focuses on the most frequent side effects of clozapine, on the relevance of slow titration, and on specific aspects of therapeutic drug monitoring (TDM). MATERIAL AND METHODS Medline, the Guideline for the use of clozapine 2013 of the Netherlands Clozapine Collaboration Group, and the S3 Guideline for Schizophrenia of the German Association for Psychiatry, Psychotherapy and Psychosomatics were searched for relevant literature, the last query dating from April 28th, 2023. RESULTS Despite its unique efficacy clozapine is underused in clinical practice and prescription varies between and within countries. Next to hematological, metabolic, and vegetative side effects, clozapine induced inflammation manifesting in the form of pneumonia or myocarditis, which is mainly associated with rapid titration, represents a major clinical challenge with CRP monitoring being of particular relevance. In this context, it also has to be noted that sex, smoking behavior, and ethnic origin impact clozapine metabolism, thus requiring personalized dosing. CONCLUSION Slow titration when possible, TDM, and CYP diagnostics when appropriate increase patient safety during treatment with clozapine and thus the likelihood of early prescription of this compound in TRS.
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Affiliation(s)
- Stefan J Berger
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Alex Hofer
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Oloyede E, Blackman G, Mantell B, Harris E, Williams J, Taylor D, MacCabe J, McGuire P. What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:26. [PMID: 37117237 PMCID: PMC10147630 DOI: 10.1038/s41537-023-00353-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/03/2023] [Indexed: 04/30/2023]
Abstract
Clozapine is the most effective medication for treatment-resistant psychosis, but evidence points to substantial underuse, especially within early intervention psychosis (EIP) services. We explored clinicians' views on perceived barriers and facilitators to offering patients clozapine within EIP services. A cross-sectional survey was distributed electronically to clinicians practising in EIP services across England. A mixed methods approach was used to assess barriers to clozapine, and attitudes and opinions concerning clozapine underutilisation. Based on the barriers identified in the literature, clinicians were asked to rate each one (scale:1-7) based on importance, with a higher score indicating higher importance. Clinicians were also asked open-ended questions on barriers to clozapine and how access can be improved in EIP services. Quantitative data were analysed using descriptive and inferential statistics, and qualitative responses were analysed thematically. One hundred and nineteen EIP clinicians from 35 services in England completed the survey. In total, 37% (n = 45) of clinicians perceived that clozapine was under-prescribed in their EIP service. The most important barrier to utilising clozapine were patient concerns with side effects, followed by monitoring requirements and clinician concerns with side effects. Thematic analysis identified 17 perceived barriers, which were grouped into three major themes: administrative (5 subthemes), clinician-related (6 subthemes), and patient-related (6 subthemes). Perceived facilitators to improving clozapine use were greater training, improved resources, and optimised monitoring. The main barriers to clozapine in EIP services, as identified by clinicians, are patient concerns regarding side effects and monitoring requirements. Identified facilitators for improved clozapine use include clinician training, improved resources, guidelines, and point-of-care testing.
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Affiliation(s)
- Ebenezer Oloyede
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Psychiatry, University of Oxford, Warneford, UK.
| | - Graham Blackman
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Warneford, UK
| | - Bethany Mantell
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eleanor Harris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Julie Williams
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, UK
| | - James MacCabe
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health South London and Maudsley NHS, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford, UK
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Silva E. Yes it should. Br J Psychiatry 2022; 220:364. [PMID: 35599578 DOI: 10.1192/bjp.2021.199] [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] [Indexed: 11/23/2022]
Affiliation(s)
- Ed Silva
- Rathbone LSU, Rathbone Hospital, Mersey Care NHS FT, Liverpool, UK.
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Maric NP, Andric Petrovic S, Russo M, Jerotic S, Ristic I, Savić B, Pemovska T, Milutinovic M, Ribic E, Markovska-Simoska S, Dzubur Kulenovic A, Jovanovic N. Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use. Front Psychiatry 2022; 13:796719. [PMID: 35463504 PMCID: PMC9022963 DOI: 10.3389/fpsyt.2022.796719] [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: 10/17/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maintenance therapy of patients with primary psychosis spectrum disorders (PSD) in the Western Balkans has received limited interest so far. The present study aimed to investigate long-term prescription patterns among outpatients with PSD. METHODS Information about prescription of antipsychotics (AP), benzodiazepines (BZD) and other psychotropic medication over a 6-month period was collected from outpatients (n = 134; ICD-10 diagnosis F20-29) recruited by a larger multi-site study, to find mean daily number of psychotropic drugs, AP prescription patterns (including AP daily dose, route of administration, monotherapy vs. polypharmacy) and BZD utilization (long-term add-on BZD therapy). Additionally, sex-differences in the variables were explored. RESULTS Clinically stable outpatients (age 41.7 ± 11.0; male 62.7%; duration of untreated illness 12.7 ± 8.7 years; mean number of lifetime hospitalizations 2.6 ± 0.7) were prescribed 2.8 ± 1.1 psychotropic medications daily. The mean 6-month AP dose was 14.2 ± 7.8 mg olanzapine equivalents. Long-acting injectable AP was prescribed to 25.2% of the patients. Long-term AP monotherapy was found in 52.7% patients and most of them were prescribed second generation AP (65.2%). Long-term AP polypharmacy (42.7%) was more common in males (p = 0.015). The most frequent co-prescription patterns were first generation AP plus clozapine. The highest rate of long-term AP co-prescription was found for BZD (in 42.7% cases, average 6-months daily dose of 2.8 ± 2.7 mg lorazepam equivalents) and anticholinergics (33.6%). CONCLUSION Existing appropriately designed interventions aiming to safely switch the inappropriate therapeutic regimens, i.e. very high prevalence of long-term AP polypharmacy and non-rational BZD co-prescription, should be implemented in the region of Western Balkans.
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Affiliation(s)
- Nadja P Maric
- Faculty of Medicine, University of Belgrade and Institute of Mental Health, Belgrade, Serbia
| | - Sanja Andric Petrovic
- Faculty of Medicine, University of Belgrade and Institute of Mental Health, Belgrade, Serbia
| | - Manuela Russo
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Stefan Jerotic
- Faculty of Medicine, University of Belgrade and Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Ristic
- Faculty of Medicine, University of Belgrade and Institute of Mental Health, Belgrade, Serbia
| | - Bojana Savić
- Faculty of Medicine, University of Belgrade and Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tamara Pemovska
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Milos Milutinovic
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Emina Ribic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Alma Dzubur Kulenovic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
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Oloyede E, Mantell B, Williams J, Lai S, Jauhar S, Taylor D, MacCabe JH, Harland R, McGuire P, Blackman G. Clozapine for treatment resistance in early psychosis: a survey of UK clinicians' training, knowledge and confidence. Ther Adv Psychopharmacol 2022; 12:20451253221141222. [PMID: 36601352 PMCID: PMC9806412 DOI: 10.1177/20451253221141222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/01/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Clozapine is the only medication licenced for patients with psychosis that is resistant to conventional antipsychotic treatment. However, despite its effectiveness, it remains widely underutilised. One contributory factor for this may be clinicians' lack of confidence around the management of clozapine. OBJECTIVE We conducted a survey of clinicians working in Early Intervention in Psychosis (EIP) services to determine their training needs for clozapine management in EIP services. METHODS An electronic survey was made available to all clinicians working in EIP services in England. The survey assessed confidence and training needs regarding managing clozapine in patients with treatment-resistant psychosis. Quantitative data were analysed using total mean scores and the Mann-Whitney U test. RESULTS In all, 192 (27%) of approximately 700 clinicians from 35 EIP services completed the survey. Approximately half (54%) had not received training on treatment with clozapine. Experience of training was higher in prescribers than non-prescribers, and among medical than non-medical clinicians. Previous training was associated with significantly higher confidence in offering clozapine and managing treatment-resistant psychosis (p < 0.001). Confidence levels with managing treatment-resistant psychosis and clozapine were relatively high (mean = 4 out of 5, SD = 1). Respondents were most confident about monitoring mental health response to treatment (mean = 5, SD = 1). Participants were least confident about how to discontinue clozapine treatment safely (mean = 3, SD = 1). CONCLUSION Most clinicians working in EIP have not received training on the use of clozapine. This may account, in part, for the underutilisation of clozapine in EIP services. The provision of training in the identification of treatment-resistant psychosis and the use of clozapine will likely improve the detection and management of treatment resistance in the early phase of psychosis.
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Affiliation(s)
- Ebenezer Oloyede
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, DeCriesney, London, UK
| | - Bethany Mantell
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Julie Williams
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - Serena Lai
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sameer Jauhar
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Pharmaceutical Science, King's College, London
| | - James H MacCabe
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health South London and Maudsley NHS, London, UK
| | - Robert Harland
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, Oxfordshire, UK
| | - Graham Blackman
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Lucca JM, Al-Turaifi FM, Safyah AM, Hamad Al-Awad FA. A Comprehensive Monitoring of Clozapine and Related Components in Clinical Practices. Saudi Arabian Scenario. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:40-50. [PMID: 34887598 PMCID: PMC8601762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Clozapine is considered as effective medication for treatment resistant schizophrenia. Due to its potential severe adverse effects' clozapine is underused in the clinical settings. Information's on clinical use and monitoring of clozapine is lacking in middle east. This research analysis clozapine prescription and monitoring patterns a in a university teaching hospital in Saudi Arabia. EXPERIMENTAL DESIGN A retrospective observational study was conducted in the psychiatric department of a university hospital in Saudi Arabia. Patients on treatment with clozapine for minimum one year were reviewed and assessed for clozapine mandatory and non-mandatory requirements and its correlated factors. OBSERVATION Majority of patients were male [(n = 36) 63%] and the average age of was 36.8 ± 12.3. TRS schizophrenia[(n = 49),85%] was the common indications. Prior to initiation of clozapine all recommended guidelines was followed for all patients (100%). In addition to the blood monitoring and vitals LFT (80.75%) and weight (87.77%) were frequently measured. Hematological work up performed routinely throughout initial 18 weeks (71.9 %) and every month (59.6%). Weight gain (29.8%) was the most documented adverse effects. CONCLUSION The current study explored experiences with clozapine prescribing practices in a university hospital KSA and suggest that clozapine prescription is completely adhered with already existing guidelines in terms of dosing and monitoring. There exist a careful balance of benefit and risk in term of adverse reaction of clozapine in the local population.
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Affiliation(s)
- Jisha M Lucca
- Dr. Lucca, Assistant professor Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Al-Turaifi, Safyah Al-Mubayedh, Pharm D Interns, Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Hamad Al-Awad, Consultant Psychiatrist Department Psychiatry, College of Medicine Imam Abdulrahman Bin Faisal University Hospital Dammam, KSA
| | - Fatima M Al-Turaifi
- Dr. Lucca, Assistant professor Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Al-Turaifi, Safyah Al-Mubayedh, Pharm D Interns, Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Hamad Al-Awad, Consultant Psychiatrist Department Psychiatry, College of Medicine Imam Abdulrahman Bin Faisal University Hospital Dammam, KSA
| | - Al-Mubayedh Safyah
- Dr. Lucca, Assistant professor Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Al-Turaifi, Safyah Al-Mubayedh, Pharm D Interns, Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Hamad Al-Awad, Consultant Psychiatrist Department Psychiatry, College of Medicine Imam Abdulrahman Bin Faisal University Hospital Dammam, KSA
| | - Feras A Hamad Al-Awad
- Dr. Lucca, Assistant professor Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Al-Turaifi, Safyah Al-Mubayedh, Pharm D Interns, Department of Pharmacy Practice, College of Clinical Pharmacy Imam Abdulrahman Bin Faisal University, Dammam, KSA. Hamad Al-Awad, Consultant Psychiatrist Department Psychiatry, College of Medicine Imam Abdulrahman Bin Faisal University Hospital Dammam, KSA
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8
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Wright TC, Du S, Hedrick RM, Cho SH. Successful continuation of clozapine treatment during hematopoietic stem cell transplantation: A step toward health equity in the oncologic care of people with severe mental illness. Psychooncology 2021; 30:2082-2086. [PMID: 34331315 DOI: 10.1002/pon.5782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Tyler C Wright
- Department of Psychiatry, University of Southern California Medical Center, Los Angeles, California, USA
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rebecca M Hedrick
- Department of Psychiatry, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie H Cho
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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9
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de Leon J, De Las Cuevas C, Sanz EJ, Verdoux H. The association of clozapine and haematological malignancies needs to be replicated by other studies and more importantly by analyses of subsamples from VigiBase. Psychol Med 2021; 51:1405-1406. [PMID: 32372739 DOI: 10.1017/s0033291720001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
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Abstract
PURPOSE/BACKGROUND To evaluate the outcome of diabetes mellitus among patients of schizophrenia who had diabetes mellitus before starting clozapine. METHODS Clozapine data were screened to detect the patients who had diabetes mellitus before starting clozapine. Those who had diabetes mellitus before starting clozapine were taken up for the study. RESULTS Of the 468 records screened, 28 patients (5.6%) had diabetes mellitus before starting clozapine. Among the 28 patients, 15 (53.6%) were females, and 13 (46.4%) were male. In three-fourths (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-six patients had type 2 diabetes mellitus and 2 patients had type 1 diabetes mellitus at the time of starting clozapine. Most patients also had deranged blood glucose levels at the time of starting clozapine and required close monitoring of blood glucose levels and also starting/continuation of antidiabetic medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the mean follow-up duration of 16 months, most patients were on regular follow-up for more than 1 year, and their blood glucose levels were maintained close to the reference range. Majority of these patients showed good response to clozapine. CONCLUSIONS The present study suggests that presence of diabetes mellitus should not stop the clinicians to use clozapine among patients with schizophrenia. However, close monitoring of blood glucose levels must be done.
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de Leon J, Ruan CJ, Schoretsanitis G, De las Cuevas C. A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:200-214. [PMID: 32289791 PMCID: PMC7206357 DOI: 10.1159/000507638] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA, .,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain, .,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain,
| | - Can-Jun Ruan
- The National Clinical Research Centre for Mental Disorders, Beijing Key Laboratory of Mental Disorders, and Laboratory of Clinical Psychopharmacology, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Georgios Schoretsanitis
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
| | - Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Spain
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12
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Uygur ÖF, Uygur H. Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1627695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ömer Faruk Uygur
- Department of Psychiatry, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Hilal Uygur
- Department of Psychiatry, Necip Fazil City Hospital, Kahramanmaras, Turkey
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13
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Affiliation(s)
- James Paul Pandarakalam
- Northwest Boroughs Healthcare NHS Foundation Trust, Hollins Park Hospital, Warrington WA2 8WN, UK
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14
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Kaur H, Sidana A, Singh T. Comparison of efficacy and tolerability of escitalopram and venlafaxine in treatment-naïve patients with unipolar nonpsychotic depression: Is there a need to revisit the prescription patterns? JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2019. [DOI: 10.4103/jmhhb.jmhhb_21_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Shah P, Iwata Y, Plitman E, Brown EE, Caravaggio F, Kim J, Nakajima S, Hahn M, Remington G, Gerretsen P, Graff-Guerrero A. The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia: A systematic review. Psychiatry Res 2018; 268:114-122. [PMID: 30015109 DOI: 10.1016/j.psychres.2018.06.070] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/26/2018] [Accepted: 06/25/2018] [Indexed: 12/29/2022]
Abstract
Approximately one-third of patients with schizophrenia have treatment-resistant schizophrenia (TR-SCZ), which is a condition characterized by suboptimal response to antipsychotics other than clozapine. Importantly, treatment with clozapine-the only antipsychotic with an indication for TR-SCZ-is often delayed, which could contribute to negative outcomes. Given that the specific impact of delay in clozapine initiation is not well understood, we aimed to conduct a systematic search of the Ovid Medline® database to identify English language publications exploring the impact of delay in clozapine initiation on treatment outcomes in patients with TR-SCZ. Additionally, clinico-demographic factors associated with clozapine delay were examined. Our search identified four retrospective studies that showed an association between longer delay in clozapine initiation and poorer treatment outcomes, even after including covariates, such as age, sex, and duration of illness. In addition, we found six studies that showed an association between age and clozapine delay, but results with regard to other clinico-demographic variables were inconsistent. Overall, the available literature reveals a possible link between delay in clozapine use and poorer treatment outcomes in patients with TR-SCZ. However, given the relatively small number of studies on this clinically important topic, future research is warranted to draw more definitive conclusions.
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Affiliation(s)
- Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan
| | - Margaret Hahn
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
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16
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Affiliation(s)
- Aynur Görmez
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşe Kurtulmuş
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Can Tuncer
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serhat Çıtak
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
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17
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Kolli V, Bourke D, Ngo J, Luber MJ, Coffey BJ. Clozapine-Related Tachycardia in an Adolescent with Treatment-Resistant Early Onset Schizophrenia. J Child Adolesc Psychopharmacol 2017; 27:206-208. [PMID: 28323458 DOI: 10.1089/cap.2017.29123.bjc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Venkata Kolli
- 1 Department of Psychiatry, Creighton University , Omaha, Nebraska
| | - Dalton Bourke
- 1 Department of Psychiatry, Creighton University , Omaha, Nebraska
| | - Jeannie Ngo
- 1 Department of Psychiatry, Creighton University , Omaha, Nebraska
| | - Maxwell J Luber
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Barbara J Coffey
- 2 Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, New York
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18
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Affiliation(s)
- Mesut Cetin
- Klinik Psikofarmakoloji Bulteni-Bulletin of Clinical Pychopharmacology, Istanbul-Turkey
| | - Gokben Hizli Sayar
- Uskudar University NP Istanbul Hospital, Psychiatry Clinic, Istanbul-Turkey
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19
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Es H, Melez IE, Ozgun A, Melez DO, Kertmen C, Cavlak M. Sudden Death Associated with Hypersensitivity Myocarditis Induced by Clozapine: An Autopsy Case. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20151216022322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Huseyin Es
- Bingol Branch of Council of Forensic Medicine, Bingol-Turkey
| | - Ipek Esen Melez
- Bezmialem Vakif University School of Medicine, Department of Forensic Medicine, Istanbul-Turkey
| | - Ayse Ozgun
- Council of Forensic Medicine, Department of Pathology, Istanbul-Turkey
| | | | - Cisem Kertmen
- Duzce Brach of Council of Forensic Medicine, Duzce-Turkey
| | - Mehmet Cavlak
- Ankara Brach of Council of Forensic Medicine, Ankara-Turkey
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