Medical management of patients on clozapine: A guide for internists

Lundblad, Wynne; Azzam, Pierre N.; Gopalan, Priya; Ross, Clint

doi:10.1002/jhm.2345

Cited by 10 publications

(9 citation statements)

References 49 publications

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“…(26) A longitudinal study pointed to a high prevalence of metabolic syndrome in people who use clozapine. (6) Important and recent studies that assessed the relationship between this syndrome and the quality of life also did not show significant association, despite the high prevalence of metabolic syndrome and low quality of life of patients. (8,9,27) Thus, the planning and implementation of strategies to minimize the risk of metabolic disorders and therefore improve treatment adherence and quality of life, should be a major focus of individual treatment plans for these patients.…”

Section: Discussionmentioning

confidence: 93%

“…(5) Approximately 30% of the patients had the resistant form, and the treatment of choice is the use of the atypical antipsychotic, clozapine. (6) Clozapine is considered a gold standard in the treatment of patients with refractory schizophrenia, and demonstrates a reduction in acute symptoms and the risk of suicide. (6) However, its use is not free of side effects, especially metabolic: weight gain, increased central adiposity, dyslipidemia, glucose intolerance, insulin resistance and high blood pressure, which characterize the metabolic syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…(6) Clozapine is considered a gold standard in the treatment of patients with refractory schizophrenia, and demonstrates a reduction in acute symptoms and the risk of suicide. (6) However, its use is not free of side effects, especially metabolic: weight gain, increased central adiposity, dyslipidemia, glucose intolerance, insulin resistance and high blood pressure, which characterize the metabolic syndrome. (7) Although these are the main and most common symptoms, there are also others associated with the use of clozapine, but without relevance to the metabolic syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Esquizofrenia refratária: qualidade de vida e fatores associados

et al. 2016

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Objective: To analyze the quality of life of people with refractory schizophrenia using clozapine, and its associated factors. Methods: A cross-sectional study, conducted in the extended western region of Minas Gerais, which included patients with refractory schizophrenia using the antipsychotic, clozapine. For the measurement of quality of life, the Quality of Life Scale was used, specific for patients with schizophrenia. Univariate and multivariate analyses were performed. Results: A total of 72 patients with a mean age of 42.9 years was part of the study. The overall score of the Quality of Life Scale indicated compromised quality of life, with a greater impairment in the social network domain (median = 2.36). The logistic regression analysis showed factors associated with a better quality of life. Conclusion: Low quality of life in patients with refractory schizophrenia was found. Physical activity, family income over three times the minimum wage, and having children were associated with a better quality of life. ResumoObjetivo: Analisar a qualidade de vida de pessoas com esquizofrenia refratária em uso de clozapina e seus fatores associados. Métodos: Estudo de delineamento transversal, realizado na Região Ampliada Oeste de Minas Gerais, que incluiu pacientes com esquizofrenia refratária em uso do antipsicótico clozapina. Para a mensuração da qualidade de vida, foi utilizada a escala Quality of Life Scale, específica para pacientes com esquizofrenia. Foram realizadas análise univariada e multivariada. Resultados: Participaram 72 pacientes, com média de idade de 42,9 anos. O escore global da Quality of Life Scale indicou qualidade de vida comprometida, com maior prejuízo no domínio rede social (mediana = 2,36). A análise de regressão logística apontou fatores associados a uma melhor qualidade de vida. Conclusão: Evidenciou-se uma baixa qualidade de vida dos pacientes com esquizofrenia refratária. Praticar atividade física, renda familiar acima de três salários mínimos e possuir filhos foram associados à melhor qualidade de vida.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Esquizofrenia refratária: qualidade de vida e fatores associados

et al. 2016

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“…Lundblad et al recommend interrupting clozapine therapy during "medical optimization" of venous thromboembolism (VTE) 1 but do not explain the rationale for interruption in their article. Diverse theories for an observed association between antipsychotics and VTE have been proposed, ranging from sedation and obesity to multifactorial hypercoagulability, 2,3 but information on how to handle VTE in antipsychotic recipients is limited.…”

Section: Ian Jenkins MDmentioning

confidence: 96%

In reference to “medical management of patients on clozapine: A guide for internists”

Jenkins

2015

Journal of Hospital Medicine

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“…Further indications for anticonvulsants as concomitant to antipsychotics in schizophrenia include protection against seizures induced by high doses of antipsychotics, specifically clozapine (Lundblad et al, 2015), as well as augmentation in treatment-resistant patients -it is postulated by Onhuma et al (2013) that the glutamatergic properties of lamotrigine may play a role in treatment resistant schizophrenia, resulting in improved response in these patients.…”

Section: Anticonvulsant Medicationmentioning

confidence: 99%

Use of concomitant medication in the treatment of schizophrenia

Oosthuizen¹,

Johannes²

2015

Afr. J. Pharm. Pharmacol.

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Schizophrenia is a lifelong disorder that requires continuous pharmacotherapy. About 10 to 30% of patients with schizophrenia show poor response to antipsychotic medication alone, therefore concomitant medication is often used. The rationale for the addition of concomitant medication is often unclear and based on limited evidence. The most frequently prescribed concomitant medications in the treatment of schizophrenia include anticholinergic medication, antidepressants, anxiolytics for example, benzodiazepines, lithium and anticonvulsant medication for example, valproex. Indications for adding these medications to antipsychotic treatment regimens vary from controlling specific symptoms associated with schizophrenia for example, anxiety symptoms, aggressive behavior and suicidality, to managing adverse effects for example, parkinsonian side effects caused by antipsychotic medication. Although there is a need for concomitant medication in the treatment of schizophrenia, each patient needs to be assessed individually since the use of concomitant medication can also have negative treatment implications, for example an increase in the occurrence of adverse effects and drug interactions. Due to the diversity of the disease profile of schizophrenia, no one adjunctive treatment benefits all patients, therefore the choice of specific treatment is best guided by the clinical characteristics and presentation of the individual patient. The aim of this paper is thus to present a qualitative review of the literature.

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Medical management of patients on clozapine: A guide for internists

Cited by 10 publications

References 49 publications

Esquizofrenia refratária: qualidade de vida e fatores associados

Esquizofrenia refratária: qualidade de vida e fatores associados

In reference to “medical management of patients on clozapine: A guide for internists”

Use of concomitant medication in the treatment of schizophrenia

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