IntroductionClozapine is the only drug approved for resistant schizophrenia, but remains underused because of its side effects. Sedation is common, but its management is unclear.ObjectivesTo analyze factors associated with clozapine-induced sedation and the efficacy of common treatment strategies.AimsTo determine clozapine-induced sedation factors and possible therapeutic strategies.MethodsUsing two years’ electronic records of a community cohort of resistant schizophrenia spectrum disorder cases on clozapine, we performed three analyses: a cross-sectional analysis of which factors were associated with number of hours slept (objective proxy of sedation), and two prospective analyses: which factors were associated with changes in hours slept, and the efficacy of the main pharmacological strategies for improving sedation.ResultsOne hundred and thirty-three patients were included; 64.7% slept at least 9 hours/daily. Among monotherapy patients (n = 30), only norclozapine levels (r = .367, P = .033) correlated with sleeping hours. Multiple regression analyses confirmed the findings (r = .865, P < .00001). Using the cohort prospectively assessed (n = 107), 42 patients decreased the number of hours slept between two consecutive appointments. Decreasing clozapine (40%) or augmenting with aripiprazole (36%) were the most common factors. In the efficacy analysis, these two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects, respectively. The majority (81.8% and 73.9%) did not report differences in the hours slept.ConclusionsSedationis common and involves pharmacological and non-pharmacological factors. The only correlation was a weak correlation between norclozapine plasma levels and total sleeping hours. Reducing clozapine and aripiprazole augmentation were the most successful strategies to ameliorate sedation, although both strategies were effective only in a limited numbers of subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionSchizophrenia is a developmental disorder that includes non-psychiatric abnormalities [2]. Metabolic abnormalities prior to antipsychotic treatment exist. The clozapine metabolic profile causes clozapine underuse in resistant schizophrenia [1].ObjectivesTo correlate metabolic profile with psychiatric severity and compare the correlations between clozapine/non-clozapine patients.AimsTo determine possible contributory factors to metabolic abnormalities in schizophrenia.MethodsWe cross-sectionally analyzed all patients from a Spanish long-term mental care facility (n = 139). Schizophrenic/schizoaffective patients were selected (n = 118). N = 31 used clozapine. We paired clozapine and non-clozapine patients by sex and age and assessed metabolic and psychopathologic variables.We compared psychopathologic variables between patients with/without cardiometabolic treatment and the differences between clozapine/non-clozapine groups.ResultsWe analyzed: 27 clozapine/29 non-clozapine patients. A total of 67,9% males with a mean age of 51.3 (SD 9.6) years. In the whole sample TG negatively correlated with Negative-CGI (r: −0,470, P: 0.049) and HDL-cholesterol correlates with Global-CGI(r: 0,505, P: 0.046). Prolactin correlated with the number of antipsychotics (r: 0.581, P: 0.023) and IMC (r: 0.575, P: 0.025). Clozapine group took less antipsychotics [Fisher (P: 0.045)] and had higher scores in total BRPS scale [t-Student (P: 0.036)]. They did not use more cardiometabolic treatment. There were no psychopathological differences between cardiometabolic treated/non-treated patients. In the non-cardiometabolic treated group (n = 35/62,5%), IMC negatively correlated with positive and total BPRS, positive, cognitive and global-CGI. We found negative correlations between metabolic parameters and psychopathology in clozapine (40%) and non-clozapine subgroups (60%). In the cardiometabolic treated group (n = 21/37,5%), we did not find these correlations in either of clozapine (61.9%) or non-clozapine (38.1%) subgroups.ConclusionsSeverity [2], prolactine [3] and treatment [1] could play a role in metabolic parameters. In our sample we found negative correlations between psychopathological and metabolic parameters.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionNon-attendance at initial appointments is an important problem in outpatient settings and has consequences, such as decreased efficient use of resources and delayed attention to patients who attend their visits, and that compromises quality of care.ObjectivesTo identify and describe the characteristics of patients who do not attend the first appointment in an adult outpatient mental health center, located in Barcelona.MethodRetrospective study. The sample was made up from all patients who had a first appointment during 2014 in our outpatient mental health centre. Socio-demographic and clinical data (type of first appointment, reason for consultation, origin of derivation, priority, history of mental health problems) were described. The results were analyzed using the SPSS statistical package.ResultsA total of 272 patients were included. Twenty-six per cent did not attend their first appointment; with mean age 39.75 years and 51.4% were male. Most frequent problems were anxiety (41.7%), depression (26.4%) and psycosis and behavioural problems (11.2%). The origin was primary care (83.3%), social services (4.2%) and emergencies (2.8%). Most of them were not preferent or urgent (86.1%). The 51.4% of non-attendees had history or psychiatric problems and 13.9% nowadays are patients of our mental health centre.ConclusionsIt is important to develop mechanisms that can reduce the incidence of first non-attended appointments. In our case, most of them are attended by primary care so we can establish better communication with our colleagues and try to contact to the patients prior to the date of the appointment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Recibido: 06/11/2012; aceptado con modificaciones: 24/03/2013 RESUMEN: Algunos antipsicóticos se asocian a discrasias sanguíneas. El psicofármaco que más produce agranulocitosis es la clozapina (0,5-2% de los pacientes). La olanzapina es un antipsicótico de segunda generación con estructura química similar a la clozapina que tiene un riesgo de leucopenia/neutropenia de 1/10.000 pacientes tratados. Presentamos el caso de un paciente de 32 años sin antecedentes somáticos ni psiquiátricos, hospitalizado por un primer episodio psicótico. En la analítica previa al ingreso no había alteraciones en el hemograma (leucocitos totales 8,92x10 3 /ul, neutrófilos totales 6,99x10 3 /ul). A los tres días de haber iniciado tratamiento con olanzapina 20mg/día el recuento leucocitario había disminuido a 2,46x10 3 /ul (neutrófilos totales 0,64x10 3 / ul). Tras sustituir la olanzapina, inicialmente por risperidona y posteriormente por zuclopentixol intramuscular, el recuento leucocitario fue aumentando progresivamente. A los doce días de la retirada, el hemograma se había normalizado (leucocitos totales 5,73x10 3 /ul).ABSTRACT: Some antipsychotics drugs are associated with blood dyscrasias. The psychotropic medication most frequently associated with agranulocytosis is clozapine (0,5-2% of patients). Olanzapine is a second-generation antipsychotic with a chemical structure similar to clozapine, with a risk of neutropenic reactions of 1/10.000 treated patients. We report the case of a 32-yearold man without medical or psychiatric records, who was admitted due to a first psychotic episode. In a blood test previous to hospitalization, complete blood cell count was normal (white blood cell count 8,92x10 3 /ul, neutrophilic count 6,99x10 3 /ul). Three days after initiation of olanzapine 20mg/day, WBC count had fallen to 2,46x10 3 /ul (neutrophilic count 0,64x10 3 /ul). After replacing olanzapine, initially for risperidone and later for intramuscular zuclopentixol, WBC count gradually increased. On the twelfth day of olanzapine withdrawal, complete blood cell count had normalized (WBC count 5,73x10 3 /ul).
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