The impact of clozapine initiation and cessation on psychiatric hospital admissions and bed days: a mirror image cohort study

Siskind, Dan; Reddel, Tim; MacCabe, James H.; Kisely, Steve

doi:10.1007/s00213-019-5179-6

Cited by 24 publications

(24 citation statements)

References 17 publications

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“…Pharmaco-epidemiological studies have consistently shown that clozapine treatment is associated with a reduction in all-cause mortality (Cho et al, 2019a; Wimberley et al, 2017), and this seems to be driven by a reduction in suicidality (Meltzer and Okayli, 1995; Meltzer et al, 2003; Wimberley et al, 2017). Clozapine has been shown to reduce admission rates compared with other antipsychotics (Kesserwani et al, 2019) and in within-patient mirror-image studies (Siskind et al, 2019), and a recent meta-analysis showed lower admission rates under clozapine than any other drug, including LAIs (Land et al, 2017). Clozapine treatment is also associated with lower rates of treatment failure than any other oral antipsychotics (Tiihonen et al, 2017).…”

Section: Treatment-resistant Schizophreniamentioning

confidence: 99%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

2019

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These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment.They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.

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Section: Treatment-resistant Schizophreniamentioning

confidence: 99%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

2019

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“…Tertiary care programs for TRS should include individually tailored psychosocial rehabilitation, as well as personalised and evidence-based medication management, to achieve flexible and effective care. 9 Clozapine is the only recommended antipsychotic treatment for TRS and is the most effective agent for reducing symptoms, 10 hospital use, 11 suicide rates, 12,13 aggressive behaviour, 14 violent crime 15 and substance misuse. 16 However, the management of clozapine therapy for patients with severe and chronic behavioural problems requires carefully developed strategies and close monitoring of adverse effects, which can be challenging in a primary or secondary care setting.…”

Section: Tertiary Services For Complex Trsmentioning

confidence: 99%

Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

et al. 2020

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Background Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs. Aims This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures. Method Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system. Results Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001). Conclusions This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.

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“…12,40,42 This minimised confounding at individual level. 73,74 We also adjusted for potential confounders in our GLMM.…”

Section: Strengthsmentioning

confidence: 99%

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

Öhlund

Ott

Lundqvist

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events ( p = 0.013) and numbers of events experienced ( p = 0.004). These effects were preserved 2 years after CS initiation. Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

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The impact of clozapine initiation and cessation on psychiatric hospital admissions and bed days: a mirror image cohort study

Cited by 24 publications

References 17 publications

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

Real-world effectiveness of admissions to a tertiary treatment-resistant psychosis service: 2-year mirror-image study

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

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