Predictors of functioning and clinical outcomes in inpatient with schizophrenia on clozapine augmented with antipsychotics

Mukherjee, Hindol; Sazhin, Vladimir

doi:10.1177/10398562211037339

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Duration of follow up varied from 3 months 14 to 3 years 21 and it was not reported in three study 16,19,24 and not applicable in one study 18 …”

Section: Resultsmentioning

confidence: 98%

“…We retrieved a total of 12 relevant articles which included two case reports, three case series and seven retrospective observational studies, four of which followed a mirrorimage design, representing a total of 195 patients (Table 1). Three studies were conducted in Turkey, 14,15 two in South Korea 16,17 two in Australia 18,19 and one in each of the following countries: Spain, 20 Canada, 21 Italy, 22 France 23 and the United States. 24 Both first-generation and second-generation antipsychotics were reported as adjunctive treatment to clozapine, although second-generation appeared more frequently.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Duration of follow up varied from 3 months 14 to 3 years 21 and it was not reported in three study 16,19,24 and not applicable in one study. 18 With regards to side effects, Bioque et al 20 reported that the combination of clozapine with LAI resulted in fewer side effects and was well tolerated. Similarly, three of the studies 17,22,23 reported that the commonly seen clozapine side effects did not arise on a combination of clozapine plus LAI antipsychotics, indicating a welltolerated combination.…”

Section: Literature Reviewmentioning

confidence: 99%

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Clozapine augmentation with long‐acting antipsychotic injections: A case series and systematic review

Oloyede,

Dima,

Taylor

et al. 2023

Acta Psychiatr Scand

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BackgroundUp to 30% of patients with a diagnosis of treatment‐resistant psychosis remain symptomatic despite an optimal trial with the gold standard treatment, clozapine. Emerging evidence suggests the clinical utility of long‐acting injections (LAI) in such clinical scenarios. In this study, we aimed to describe clozapine augmentation with LAIs in an inner London hospital and explore the literature on the clinical effectiveness of this treatment modality.MethodsPatients prescribed clozapine, who were commenced on a LAI between 2007 and 2023 by the United Kingdom's largest mental health trust, were identified from electronic patient records. First, routine clinical data were used to describe the use, effectiveness, and safety of this augmentation strategy. Second, we conducted a literature search up to 1st June 2023 to identify published studies describing clinical outcomes after clozapine augmentation with a LAI. Clinical outcomes were collated and presented in a table, including hospitalisation rates and quantitative clinical assessments using validated scales.ResultsOf the 1248 patients prescribed clozapine in SLaM, three patients (0.2%) received augmentation with the following LAIs: olanzapine embonate, paliperidone palmitate and pipotiazine palmitate. This treatment strategy was clinically effective and generally well tolerated in all three cases. Twelve published studies between 2010 and 2022 were included in the review. Eight distinct LAIs were reported (4 first and 4 second generation antipsychotics), with risperidone and paliperidone most widely studied. All the identified studies were observational including mirror‐image studies, case series and case reports. Duration of follow up varied from 3 months to 3 years. There was evidence that the use of LAIs with clozapine can significantly reduce clinical symptoms, hospitalisation rates and bed days. No serious adverse effects were reported.ConclusionThis preliminary evidence suggests clinical utility of LAIs in alleviating residual symptoms and subsequently reducing hospitalisation rates in patients optimised on clozapine treatment. The current study warrants further investigations including a randomised controlled study to establish the clinical efficacy, tolerability, and place in therapy of this treatment modality.

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“…Duration of follow up varied from 3 months 14 to 3 years 21 and it was not reported in three study 16,19,24 and not applicable in one study 18 …”

Section: Resultsmentioning

confidence: 98%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Clozapine augmentation with long‐acting antipsychotic injections: A case series and systematic review

Oloyede,

Dima,

Taylor

et al. 2023

Acta Psychiatr Scand

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“…The severity of symptoms, at the time of the first antipsychotic prescription in the observation window, was assessed using two items from the Health of the Nation Outcome Scale (HoNOS): (i) problems associated with hallucinations and delusions and (ii) problems with activities of daily living ( Mukherjee and Sazhin, 2022 ; Wing et al., 1998 ). Given the multiple assessments, we used a hierarchy: first, we retrieved the HoNOS scores in the 3 months before the first antipsychotic prescription; if none were available, we searched for information in the 3 months after the first antipsychotic prescription; if this was also unavailable, we retrieved the most recent HoNOS scores before the first antipsychotic prescription.…”

Section: Methodsmentioning

confidence: 99%

Clinical correlates of early onset antipsychotic treatment resistance

et al. 2022

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Background: There is evidence of heterogeneity within treatment-resistant schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and others becoming treatment-resistant after an initial response period. These groups may have different aetiologies. Aim: This study investigates sociodemographic and clinical correlates of early onset of TRS. Method: Employing a retrospective cohort design, we do a secondary analysis of data from a cohort of people with TRS attending the South London and Maudsley. Regression analyses were conducted to identify the correlates of the length of treatment to TRS. Predictors included the following: gender, age, ethnicity, problems with positive symptoms, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics. Results: In a cohort of 164 people with TRS (60% were men), the median length of treatment to TRS was 3 years and 8 months. We observed no cut-off on the length of treatment until TRS presentation differentiating between early and late TRS (i.e. no bimodal distribution). Having mild to very severe problems with hallucinations and delusions at the treatment start was associated with earlier TRS (~19 months earlier). In sensitivity analyses, including only complete cases (subject to selection bias), treatment with a long-acting injectable antipsychotic was additionally associated with later TRS (~15 months later). Conclusion: Our findings do not support a clear separation between early and late TRS but rather a continuum of the length of treatment before TRS onset. Having mild to very severe problems with positive symptoms at treatment start predicts earlier onset of TRS.

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“…[1][2][3] Although the literature on the effect of clozapine augmentation on functional outcomes as opposed to the management of positive symptoms is even less available, a recent cross-sectional study comparing parenteral and oral augmentation with clozapine showed an improvement in functioning as determined by one HoNOS (Health of the Nation Outcome Scales) item in the parenteral arm. 4 Given that positive symptoms as well as anxiety, negative, and cognitive symptoms have been shown to impact functional outcomes, [5][6][7] this study addressed the association of antipsychotics prescribed routinely to reduce positive symptoms in addition to clozapine on functioning measures collected in clinical practice.…”

mentioning

confidence: 99%

Is antipsychotic augmentation associated with improved functioning in patients on clozapine?

Cho,

Mukherjee,

Sazhin

2024

Australas Psychiatry

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Objective We aimed at exploring the relationship between functional outcomes in patients on clozapine augmented with antipsychotics in treatment-resistant schizophrenia using standard outcome measures Health of Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16). Method In a cross-sectional study of 83 patients on clozapine treated in a psychiatric rehabilitation hospital, the association between the primary outcome measure, LSP-16 including its subscales, and treatment with antipsychotic augmentation (AA) were analysed using linear regression. Result The presence of moderate-to-severe positive symptoms on the HoNOS 6 dichotomised item measure was the only statistically significant predictor of functional impairment as determined by total LSP-16 score. The group of patients with ongoing positive symptoms (partial responders) were characterised by higher total LSP-16 scores, higher numbers of AA agents, and higher chlorpromazine equivalence. There was an inverse linear relationship between chlorpromazine equivalence of AA and total score of LSP-16 scale in the group of partial responders. Conclusion Augmentation with other antipsychotic agents was associated with higher functioning in a cross-sectional study of patients with schizophrenia with poor response of positive symptoms to clozapine. This might be an important clinical factor to consider when prescribing antipsychotics to patients with clozapine-resistant schizophrenia.

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Predictors of functioning and clinical outcomes in inpatient with schizophrenia on clozapine augmented with antipsychotics

Cited by 4 publications

References 14 publications

Clozapine augmentation with long‐acting antipsychotic injections: A case series and systematic review

Clozapine augmentation with long‐acting antipsychotic injections: A case series and systematic review

Clinical correlates of early onset antipsychotic treatment resistance

Is antipsychotic augmentation associated with improved functioning in patients on clozapine?

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