Clozapine Use in First-Episode Psychosis

Tang, Charmaine; Subramaniam, Mythily; Ng, Boon Tat; Abdin, Edimansyah; Poon, Lye Yin; Verma, Swapna

doi:10.4088/jcp.15m10063

Cited by 16 publications

(20 citation statements)

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“…They found that the mean duration between their initial treatment to the commencement of clozapine was 3.2 years, with approximately three trials of different antipsychotics prior. Older age at diagnosis, previous suicide attempt and positive family history of schizophrenia were significant positive predictors to the initiation of clozapine.In 2016, Tang et al reported a retrospective study conducted between 2001 and 2012 to investigate clozapine prescribing pattern in Singapore (C Tang et al, 2016)…”

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confidence: 99%

Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder: A literature review

Thien

O’Donoghue

2018

Early Intervention Psych

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confidence: 99%

Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder: A literature review

Thien

O’Donoghue

2018

Early Intervention Psych

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“…Such a finding may prompt psychiatrists to consider a trial of Clozapine, a second-generation antipsychotic which is associated with better outcomes, but is typically not used as a first-line agent due to the increased need for monitoring and higher risk of adverse effects. 95–97 In such cases, clinicians departing from the standard of care may be protected under what some refer to as the “reasonable innovation rule,” which allows clinicians in the U.S. some degree of flexibility when they depart from the standard of care to conduct clinical innovations even if these innovations caused harm to patients. 98–101 The purpose of this rule is to allow clinicians to innovate to address a patient’s unique needs but, among other things, clinicians need to have carefully considered alternatives, and any available literature or evidence to suggest the innovative intervention might work.…”

Section: Clinic-level Challengesmentioning

confidence: 99%

Integrating Genomics into Psychiatric Practice: Ethical and Legal Challenges for Clinicians

Ward¹,

Kostick

Lázaro‐Muñoz³

2019

Harv Rev Psychiatry

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Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients’ symptoms. However, the field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions) needs to address numerous challenges to promote the responsible translation of psychiatric genomics technologies and knowledge. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize existing literature on how clinicians feel about the use of genomics in psychiatry, and analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels. Structural challenges are defined as aspects of the larger system of psychiatric practice that constitute potential barriers to the responsible integration of genomics for the purposes of psychiatric care and prevention. These structural challenges exist at a level where they can be intervened upon by professional groups that set standards and regulate the practice of psychiatry and genomics. Clinic-level challenges are day-to-day issues clinicians will face when managing genomic tests in the clinic. We discuss the need for action to mitigate these challenges and maximize the clinical and social utility of psychiatric genomics, including: expanding genomics training among mental health clinicians; establishing practice guidelines that consider potential clinical, psychological, and social implications of psychiatric genomics; promoting an integrated care model for managing genomics in psychiatry; emphasizing patient engagement and informed consent when managing genomic testing in psychiatric care.

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“…One study examined the use of clozapine in a cohort of consecutive FES patients with a 2-year follow-up. 18 Although patients who received clozapine had more positive and negative symptoms at baseline, they managed to reach rates of remission and recovery similar to those who had never received clozapine, indicating additional effects of clozapine for FES. Another study showed a robust response to clozapine for FES patients who had not responded well to initial trials of second-generation antipsychotic drugs.…”

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confidence: 93%

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

Drosos

Brønnick

Joa

et al. 2020

J Clin Psychopharmacol

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Background Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up. Methods A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year of follow-up. The symptom remission criteria were those defined by the Remission in Schizophrenia Working Group. The adherence to the pharmacological guidelines was assessed by reading the medical files and by a digital search of the words “clozapine,” “klozapin,” and “Leponex” in the hospital electronic data system. Results The majority (n = 53, 67.9%) of the patients included were nonremitted at the 1-year follow-up. The majority of the nonremitted patients received either none (7.5%), one (56.6%), or 2 types (15.1%) of antipsychotic drugs during the first year of follow-up. Only 2 (3.8%) received treatment with clozapine, and 3 (5.7%) in total were offered it. Conclusions For our FES sample, there was a low 1-year remission rate and a poor adherence to the pharmacological guidelines. Higher adherence to treatment guidelines with a more intensified antipsychotic treatment, which in some cases will include clozapine, will enhance the quality of treatment and may enhance the rates of remission for schizophrenia.

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Clozapine Use in First-Episode Psychosis

Cited by 16 publications

References 0 publications

Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder: A literature review

Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder: A literature review

Integrating Genomics into Psychiatric Practice: Ethical and Legal Challenges for Clinicians

One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia

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