Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

Wilson, Samuel; Hamilton, Ross; Callender, John S.; MacManus, Angela; Howitt, Sheila; Okpo, Blessing

doi:10.1192/pb.bp.112.040352

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…We also found the proportion of clozapine-treated patients receiving augmentation with a second antipsychotic had steadily increased throughout the study period, going from 19.1% to 36.2% (Table 5 ). The percentage of patients receiving antipsychotic augmentation in this study, i.e., 32.3%, was in the same ballpark as a UK study that declared 30% 48 . By the end of the study period, the percentage of patients using a second SGA as the augmentation agent among all augmentation patients had also increased significantly (32.2–65.5% ) (Table 5 ).…”

Section: Discussionsupporting

confidence: 65%

Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006–2017

Lin

Chan

Hsu

et al. 2020

Sci Rep

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Clozapine treatment remains the gold standard for treatment-resistant schizophrenia. This study aimed to describe temporal trends in clozapine use at discharge among patients with schizophrenia at two of the largest public psychiatric hospitals in Taiwan over a twelve-year period. Patients with schizophrenia discharged from the two study hospitals between 2006 and 2017 (n = 24,101) were included in the analysis. Antipsychotic augmentation was defined as concomitant use of a second antipsychotic as augmentation to clozapine treatment. Changes in the rate of clozapine use and antipsychotic augmentation at discharge over time were analyzed using the Cochran-Armitage trend test. Patients discharged on clozapine had significantly longer hospital stays than other patients. The rate of clozapine use at discharge increased from 13.8% to 20.0% over time (Z = 6.88, p < .0001). Concomitant use of anticholinergic medication was more common in patients receiving antipsychotic augmentation than clozapine antipsychotic monotherapy. Among patients discharged on clozapine, the rate of augmentation with a second antipsychotic increased from 19.1% to 36.2% over time (Z = 6.58, p < .0001). Among patients receiving antipsychotic augmentation, use of another second-generation antipsychotic as the augmentation agent grew from 32.6% to 65.5% over time (Z = 8.90, p < .0001). The increase in clozapine use was accompanied by an increase in concomitant use of a second antipsychotic as augmentation during the study period. Further studies are warranted to clarify the risk/benefit of this augmentation strategy. Clozapine may still be underutilized, and educational programs are needed to promote clinical use of clozapine.

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Section: Discussionsupporting

confidence: 65%

Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006–2017

Lin

Chan

Hsu

et al. 2020

Sci Rep

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“…Ireland's 4th annual child and adolescent mental health service report details 'striking patterns in the number of [self-harm] presentations seen': 51% of presentations were in the 8-hour period of 7pm to 3am. 1 This finding appears typical for paediatric psychiatry liaison services around the UK.…”

Section: Neuroimaging In Dementia: How Best To Use the Guidelines?mentioning

confidence: 82%

“…Hyoscine hydrobromide is widely used as a first-line treatment, despite little available evidence. 1 Alternatives are limited, but 19 different agents are listed in the Maudsley Prescribing Guidelines, 1 including antipsychotics, antidepressants and other drugs with antimuscarinic properties. There are few meaningful trials.…”

Section: Factors Associated With the Use Of Community Treatment Ordersmentioning

confidence: 99%

Options in managing alternatives to hyoscine in clozapine-induced hypersalivation: a survey of secure services consultants

Kasmi¹

2014

Psychiatr. Bull.

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A retrospective survey of contemporaneous electronic case records in a male psychiatric intensive care unit (PICU) in central London was carried out for 2012. The notes were scrutinised for records of serious violence where there was threat to life or limb that resulted in patients being given rapid tranquillisation and seclusion. The survey revealed that of 72 admitted individuals, 58% were responsible for this degree of behaviour. Most incidents (67%) were perpetrated in multiples by slightly fewer than 25% of all those who were admitted. This suggests an average of 3 serious incidents per patient.In a meta-analysis on in-patient aggression, 1 a literature review shows that the estimated percentage of aggression on acute admission wards is extremely variable, with figures quoted from 8 to 44%. A third of in-patients have experienced violent or threatening behaviour, with higher figures for staff -41% of clinical staff and almost 80% of nursing staff working in in-patient units have experienced aggressive behaviour. It is important therefore to understand the strength of association between risk factors for in-patient aggression and the extent to which these disruptive and distressing events can be predicted and prevented.In the present retrospective survey, it was clear from the data that the incidence of violence decreased consistently week on week; 45% of all behaviours (n¼80) requiring emergency nursing intervention occurred in the first week of all admissions. This reduced to 15% by the second week and 7.5% by the third week, however, by week 8 there was a rise to 13%. This is an interesting observation which may indicate the point at which PICU becomes counterproductive. Department of Health guidelines for PICU admission recommend that admission should not ordinarily exceed 8 weeks. 2The observation that the first week represents the highest risk period of an admission fits in well with previous data. This high-risk period could be an opportunity to monitor imminent behaviours through routine enhanced nursing observations, allowing a proactive rather than reactive response style bearing the brunt of staff/patient interactions.3,4 The observations of week-on-week reduction in serious violence could be explored further with a case-control study. Although resource intensive, ultimately any procedure that is likely to reduce violence to staff and patients is worth pursuing.

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Reporting of clozapine-induced gastrointestinal hypomotility and factors associated with fatal outcomes in Canada: A pharmacovigilance database study

Liu

Maruf

Bousman

2020

Psychiatry Research

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Clozapine antipsychotic polypharmacy: audit of use and patient monitoring

Cited by 5 publications

References 16 publications

Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006–2017

Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006–2017

Options in managing alternatives to hyoscine in clozapine-induced hypersalivation: a survey of secure services consultants

Reporting of clozapine-induced gastrointestinal hypomotility and factors associated with fatal outcomes in Canada: A pharmacovigilance database study

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