Focussing on the fundaments – assessing and treating Clozapine Induced Gastrointestinal Hypomotility

Blackman, Graham; Kapila, Adisha; Großkopf, Charlotte M.; Dratcu, Luiz

doi:10.1080/13651501.2019.1710538

Cited by 3 publications

(7 citation statements)

References 11 publications

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“…Measurement Tool to Assess Systematic Reviews 2 has 16 items on 7 critical domains, guiding authors to interpret weaknesses of the reviewed studies in critical and non-critical domains [16] . The suggested gradings are: ‘critically low’, ‘low’, ‘moderate’, and ‘high’ [11] . A ‘critically low’ grade indicates the review study has more than 1 critical flaw.…”

Section: Methodsmentioning

confidence: 99%

“…A ‘critically low’ grade indicates the review study has more than 1 critical flaw. A ‘low’ grade indicates that the review study has 1 critical flaw with or without non-critical flaw [11] . A ‘moderate’ grade indicates more than 1 non-critical flaw in the review study, and a ‘high’ grade means 0 or 1 non-critical flaw (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…[10] However, it can be successfully treated with simple interventions in an acute inpatient setting. [11] If side effects can be closely monitored and managed, why are prescribing rates so low? Previous studies reveal that top clozapine barriers include fears of side effects and prescriber discomfort with clozapine.…”

Section: Introductionmentioning

confidence: 99%

“…Signs of Clozapine-Induced Gastrointestinal Hypomotility include severe constipation, ileus, and bowel obstruction [10] . However, it can be successfully treated with simple interventions in an acute inpatient setting [11] …”

Section: Introductionmentioning

confidence: 99%

“…[ 10 ] However, it can be successfully treated with simple interventions in an acute inpatient setting. [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

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Clozapine prescribing barriers in the management of treatment-resistant schizophrenia

et al. 2021

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Background:Treatment-resistant schizophrenia is prevalent and difficult to manage, as patients fail multiple antipsychotic trials before being considered as treatment-resistant. Currently clozapine is the only Food and Drug Administration-approved pharmacotherapy for treatment-resistant schizophrenia but remains under-prescribed. The purpose of this study is to investigate recent literature on clozapine in order to identify barriers to prescribing clozapine and categorize the recommended solutions.Methods:We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using free text and the medical subject headings, we searched MEDLINE/PubMed electronic bibliographic database from 2017 until 2020. Eligible studies included peer-reviewed English language articles with multiple methodologies aiming to identify clozapine barriers in treatment-resistant schizophrenia. We used search terms combining clozapine AND treatment OR treatment-resistant schizophrenia AND barriers AND prescribing OR prescription OR prescriber. We merged search results in a citation manager software, removed duplicates, and screened the remaining articles based on the study eligibility criteria.Results:We retrieved 123 studies, however, only 10 articles exclusively met the study inclusion criteria for full text review. These studies represented 20 countries; 6 were exclusively conducted in the US. The top barriers delineated by the studies include: providers’ lack of knowledge and training (n = 7), concern about side effects (n = 8), and poor adherence (n = 7). All studies described more than 1 barrier. Other barriers included prescriber-perceived barriers (n = 4), administrative barriers (n = 5), and other healthcare systems-related barriers (n = 3). Top recommendations to overcome clozapine prescription barriers included improving prescriber clozapine education/training, utilizing interdisciplinary teams and providing integrated care via clozapine clinics, and simplifying blood test monitoring.Conclusion:Clozapine remains under-prescribed for patients with treatment-resistant schizophrenia due to multiple barriers related to the individual prescriber, system of care, and technology. It is recommended that by improving prescriber knowledge and training, use of integrated care, and use of technology that can enable continuous, real-time blood test monitoring, these barriers may be overcome.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[ 10 ] However, it can be successfully treated with simple interventions in an acute inpatient setting. [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

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Clozapine prescribing barriers in the management of treatment-resistant schizophrenia

et al. 2021

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Clozapine

2020

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Gastrointestinal and liver disease in patients with schizophrenia: A narrative review

Grant¹,

Brindle²,

Donnelly³

et al. 2022

World J Gastroenterol

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Schizophrenia is a severe mental illness which can have a devastating impact on an individual’s quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.

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Focussing on the fundaments – assessing and treating Clozapine Induced Gastrointestinal Hypomotility

Cited by 3 publications

References 11 publications

Clozapine prescribing barriers in the management of treatment-resistant schizophrenia

Clozapine prescribing barriers in the management of treatment-resistant schizophrenia

Clozapine

Gastrointestinal and liver disease in patients with schizophrenia: A narrative review

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