Roisin Doyle1, Caragh Behan, Donal OʼKeeffe, Sarah Masterson, Anthony Kinsella, Aine Kelly, Ann Sheridan, Dolores Keating, Caroline Hynes, Kevin Madigan, Elizabeth Lawlor, Mary Clarke. 1. From the *Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock; †Research Department, Saint John of God Hospitaller Ministries, Stillorgan, County Dublin; ‡School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin; §Pharmacy Department, Saint John of God Hospital, Stillorgan, County Dublin; ∥Saint John of God Community Mental Health Services, Stillorgan, County Dublin; #School of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin; and **School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland.
Abstract
PURPOSE/ BACKGROUND: For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. METHODS/PROCEDURES: Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171). Data were obtained from first presentation up to December 31, 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit. FINDINGS/ RESULTS: Twenty-eight (16.3%) of the cohort were prescribed clozapine. Data were available for 24 individuals. Of this clozapine subsample, the mean age at baseline was 23.11 (SD = 4.58); 82.14% (n = 23) were male; and 82.14% (n = 23) had a baseline diagnosis of schizophrenia. The mean time to first trial of clozapine was 6.7 years. The mean number of antipsychotics prescribed before clozapine trial was 4.85. After the initiation of clozapine, the mean number of hospital admissions reduced from 6.04 per year to 0.88 per year. IMPLICATIONS/ CONCLUSIONS: Nearly 1 in 5 of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. The use of clozapine for treatment-resistant schizophrenia is underutilized, and better understanding of the barriers to prescribing clozapine is necessary given the implications for patient's quality of life and hospital admission rates. Physical health data further emphasizes the importance of physical health monitoring in this vulnerable population.
PURPOSE/ BACKGROUND: For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. METHODS/PROCEDURES: Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171). Data were obtained from first presentation up to December 31, 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit. FINDINGS/ RESULTS: Twenty-eight (16.3%) of the cohort were prescribed clozapine. Data were available for 24 individuals. Of this clozapine subsample, the mean age at baseline was 23.11 (SD = 4.58); 82.14% (n = 23) were male; and 82.14% (n = 23) had a baseline diagnosis of schizophrenia. The mean time to first trial of clozapine was 6.7 years. The mean number of antipsychotics prescribed before clozapine trial was 4.85. After the initiation of clozapine, the mean number of hospital admissions reduced from 6.04 per year to 0.88 per year. IMPLICATIONS/ CONCLUSIONS: Nearly 1 in 5 of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. The use of clozapine for treatment-resistant schizophrenia is underutilized, and better understanding of the barriers to prescribing clozapine is necessary given the implications for patient's quality of life and hospital admission rates. Physical health data further emphasizes the importance of physical health monitoring in this vulnerable population.
Authors: Sherry Kit Wa Chan; Hei Yan Veronica Chan; William G Honer; Tarun Bastiampillai; Yi Nam Suen; Wai Song Yeung; Ming Lam; Wing King Lee; Roger Man King Ng; Christy Lai Ming Hui; Wing Chung Chang; Edwin Ho Ming Lee; Eric Yu Hai Chen Journal: Schizophr Bull Date: 2021-03-16 Impact factor: 9.306
Authors: Imogen Stokes; Siân Lowri Griffiths; Rowena Jones; Linda Everard; Peter B Jones; David Fowler; Joanne Hodgekins; Tim Amos; Nick Freemantle; Vimal Sharma; Max Marshall; Swaran P Singh; Max Birchwood; Rachel Upthegrove Journal: BJPsych Open Date: 2020-09-17