Antipsychotic prescribing patterns on admission to and at discharge from a tertiary care program for treatment-resistant psychosis

Lee, Lik Hang N.; Procyshyn, Ric M.; White, Ralph de Vere; Woodward, Todd S.; Honer, William G.; Barr, Alasdair M.

doi:10.1371/journal.pone.0199758

Cited by 9 publications

(11 citation statements)

References 48 publications

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“…However, currently available evidence suggests that APP is strongly associated with high/excessive dosing trends in routine practice. 35 According to the previously mentioned large 10-year cohort study, 16 the daily doses of APs were substantially increased in both calculations "DDD" and "CPZeq" during the 10 year periods. The yearly DDD in AMP patients also significantly increased, however, it was found to double in APP patients indicating that APP is mainly utilized for augmenting inadequate efficacy rather than counteracting SEs.…”

Section: What Concerns Should We Have In the Use Of App In Routine Prmentioning

confidence: 94%

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Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Pae

2020

Chonnam Med J

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Antipsychotics have been utilized as the standard treatment for schizophrenia regardless of illness phase where antipsychotic monotherapy (APM) is routinely recommended as the gold standard rather than antipsychotic polypharmacy (APP). However, approximately 20 to 40% of patients with schizophrenia do not respond to APM based on randomized controlled clinical trials and large practical clinical trials indicating that the subgroup of patients with schizophrenia would need differential treatment approaches beyond traditional treatment strategies such as APM. Numerous studies have supported the use of APP in particular for patients with certain clinical situations including: failure to show efficacy or tolerability from treatment with APM, need for different treatment for targeting specific symptom domains, severe illness, failure to treatment with clozapine, skepticism about following treatment guidelines, or cross titration periods. Furthermore, recent large cohort studies and practical clinical trials have proposed more benefits of APP rather than APM in terms of rehospitalization, mortality, and specific symptoms. APP has recently become more widely utilized and recognized as one of the next treatment strategies to clinicians for patients with schizophrenia. Some experts have already proposed the revision of treatment guidelines incorporating APP as evidence-based treatment option for certain patients with schizophrenia. Taken together, APP now deserves an evidence-based and acceptable treatment strategy, not an empirical or preferential treatment approach for treatment of schizophrenia in contemporary clinical practice.

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Section: What Concerns Should We Have In the Use Of App In Routine Prmentioning

confidence: 94%

“…However, currently available evidence suggests that APP is strongly associated with high/excessive dosing trends in routine practice. 35 …”

Section: What Concerns Should We Have In the Use Of App In Routine Prmentioning

confidence: 99%

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Pae

2020

Chonnam Med J

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Section: Discussionmentioning

confidence: 99%

“…12 Thus, hospitalisations could be considered appropriate moments for deprescribing, because healthcare professionals can closely monitor the patients, and successful hospital-based deprescribing programmes for antipsychotics have been described. 26,27 Prior use of clozapine and having already tried at least two different antipsychotics increased the risk of being prescribed APP. These findings suggest that TRS or subjective TRS (i.e.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation

Lagreula

Timary

Elens³

et al. 2022

Therapeutic Advances in Psychopharmacology

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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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“…The SGA clozapine is the preferred drug for treatment resistant psychosis (11)(12)(13)(14)(15), producing therapeutic responses in approximately 30% of patients previously refractory to other antipsychotics (16)(17)(18), possibly reflecting a unique mechanism of action based on its complex pharmacology (19).…”

Section: Introductionmentioning

confidence: 99%

A Focused Review of the Metabolic Side-Effects of Clozapine

et al. 2021

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The second generation antipsychotic drug clozapine represents the most effective pharmacotherapy for treatment-resistant psychosis. It is also associated with low rates of extrapyramidal symptoms and hyperprolactinemia compared to other antipsychotic drugs. However, clozapine tends to be underutilized in clinical practice due to a number of disabling and serious side-effects. These are characterized by a constellation of metabolic side-effects which include dysregulation of glucose, insulin, plasma lipids and body fat. Many patients treated with clozapine go on to develop metabolic syndrome at a higher rate than the general population, which predisposes them for Type 2 diabetes mellitus and cardiovascular disease. Treatments for the metabolic side-effects of clozapine vary in their efficacy. There is also a lack of knowledge about the underlying physiology of how clozapine exerts its metabolic effects in humans. In the current review, we focus on key studies which describe how clozapine affects each of the main symptoms of the metabolic syndrome, and cover some of the treatment options. The clinical data are then discussed in the context of preclinical studies that have been conducted to identify the key biological substrates involved, in order to provide a better integrated overview. Suggestions are provided about key areas for future research to better understand how clozapine causes metabolic dysregulation.

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Antipsychotic prescribing patterns on admission to and at discharge from a tertiary care program for treatment-resistant psychosis

Cited by 9 publications

References 48 publications

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation

A Focused Review of the Metabolic Side-Effects of Clozapine

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