D Siskind1,2, T Reddel3,4, J H MacCabe5, S Kisely6,3. 1. Metro South Addiction and Mental Health Service, Brisbane, Australia. d.siskind@uq.edu.au. 2. School of Medicine, University of Queensland, Brisbane, Australia. d.siskind@uq.edu.au. 3. School of Medicine, University of Queensland, Brisbane, Australia. 4. The Park Centre for Mental Health, Brisbane, Australia. 5. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 6. Metro South Addiction and Mental Health Service, Brisbane, Australia.
Abstract
BACKGROUND: Clozapine is the most effective medication for the positive symptoms of treatment-refractory schizophrenia. Although clozapine use is associated with fewer admissions, less is known about the impact of clozapine cessation on hospitalisation. AIMS: The aims of this study were to investigate whether clozapine-reduced psychiatric inpatient admissions and bed days, and investigate patient factors associated with these changes from a sample of 1906 people commenced on clozapine. METHODS: All people commencing clozapine during an acute hospitalisation over a 10-year period in Queensland, Australia, were included in this retrospective cohort study. A mirror image design was used to compare psychiatric bed days and hospitalisations 2 years before and after clozapine treatment, and the impact of clozapine continuation or early cessation. Changes in psychiatric bed days and hospitalisations were analysed using linear regression, adjusting for the duration on clozapine, sex, age, indigenous status, country of origin and time to clozapine commencement. RESULTS/OUTCOMES: There was a significant reduction in bed days (29.55 days vs 24.46 days, p < 0.001) and admissions (2.27 vs 1.87 < 0.001) associated with clozapine commencement. This remained significant among clozapine continuers, but not among those with early cessation. Longer duration on clozapine was associated with greater reductions in psychiatric bed days and admissions. Age, sex and time to clozapine commencement, indigeneity and country of origin did not impact outcomes. CONCLUSION/ INTERPRETATION: Longer clozapine therapy led to a greater reduction in psychiatric bed days and hospitalisations. Early cessation was associated with a return to pre-clozapine levels of bed days and admissions.
BACKGROUND: Clozapine is the most effective medication for the positive symptoms of treatment-refractory schizophrenia. Although clozapine use is associated with fewer admissions, less is known about the impact of clozapine cessation on hospitalisation. AIMS: The aims of this study were to investigate whether clozapine-reduced psychiatric inpatient admissions and bed days, and investigate patient factors associated with these changes from a sample of 1906 people commenced on clozapine. METHODS: All people commencing clozapine during an acute hospitalisation over a 10-year period in Queensland, Australia, were included in this retrospective cohort study. A mirror image design was used to compare psychiatric bed days and hospitalisations 2 years before and after clozapine treatment, and the impact of clozapine continuation or early cessation. Changes in psychiatric bed days and hospitalisations were analysed using linear regression, adjusting for the duration on clozapine, sex, age, indigenous status, country of origin and time to clozapine commencement. RESULTS/OUTCOMES: There was a significant reduction in bed days (29.55 days vs 24.46 days, p < 0.001) and admissions (2.27 vs 1.87 < 0.001) associated with clozapine commencement. This remained significant among clozapine continuers, but not among those with early cessation. Longer duration on clozapine was associated with greater reductions in psychiatric bed days and admissions. Age, sex and time to clozapine commencement, indigeneity and country of origin did not impact outcomes. CONCLUSION/ INTERPRETATION: Longer clozapine therapy led to a greater reduction in psychiatric bed days and hospitalisations. Early cessation was associated with a return to pre-clozapine levels of bed days and admissions.
Authors: Cherrie Galletly; David Castle; Frances Dark; Verity Humberstone; Assen Jablensky; Eóin Killackey; Jayashri Kulkarni; Patrick McGorry; Olav Nielssen; Nga Tran Journal: Aust N Z J Psychiatry Date: 2016-05 Impact factor: 5.744
Authors: Jari Tiihonen; Jouko Lönnqvist; Kristian Wahlbeck; Timo Klaukka; Leo Niskanen; Antti Tanskanen; Jari Haukka Journal: Lancet Date: 2009-08-22 Impact factor: 79.321
Authors: Sophie E Legge; Marian Hamshere; Richard D Hayes; Johnny Downs; Michael C O'Donovan; Michael J Owen; James T R Walters; James H MacCabe Journal: Schizophr Res Date: 2016-05-19 Impact factor: 4.939
Authors: Louise Öhlund; Michael Ott; Robert Lundqvist; Mikael Sandlund; Ellinor Salander Renberg; Ursula Werneke Journal: Ther Adv Psychopharmacol Date: 2020-08-06
Authors: Graham Blackman; Ebenezer Oloyede; Mark Horowitz; Robert Harland; David Taylor; James MacCabe; Philip McGuire Journal: Schizophr Bull Date: 2022-01-21 Impact factor: 9.306
Authors: Wei Li; Yan Liu; Haifeng Jiang; Jiang Du; Yan Zhao; Zheyi Du; Shuo Li; Haihong Wang Journal: Front Psychiatry Date: 2022-02-15 Impact factor: 4.157
Authors: Louise Öhlund; Michael Ott; Malin Bergqvist; Sofia Oja; Robert Lundqvist; Mikael Sandlund; Ellinor Salander Renberg; Ursula Werneke Journal: BJPsych Open Date: 2019-11-22