Time to rehospitalization in patients with schizophrenia discharged on first generation antipsychotics, non-clozapine second generation antipsychotics, or clozapine

Werneck, Ana Paula; Hallak, Jaime Eduardo Cecílio; Nakano, Eduardo Yoshio; Elkis, Hélio

doi:10.1016/j.psychres.2011.04.004

Cited by 28 publications

(28 citation statements)

References 19 publications

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“…Antipsychotic use at the index discharge may be a proxy for severity of symptoms in this population, which could explain why these individuals would be at higher risk of readmission compared to those taking no antipsychotics. However, previous literature has also indicated that first generation antipsychotic use may be accompanied by more side effects than second-generation antipsychotics (Werneck et al 2011), which could explain why only those in the using first generation antipsychotics differed significantly from the reference group.…”

Section: Discussionmentioning

confidence: 95%

Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences?

Rieke

McGeary

Schmid

et al. 2015

Community Ment Health J

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The objectives of the study were to compare characteristics of women and men discharged from an inpatient psychiatric facility and to identify gender-specific risk factors associated with 30-day and 1-year readmission using administrative data. The sample included adults discharged from an inpatient psychiatric facility in a Midwestern city (N = 1853). The analysis showed that the 30-day readmission rate was significantly lower among women, but there was no difference in the 1-year readmission rate. Risk factors for readmission differed by gender. For example, for 30-day readmission, being on Medicare versus commercial insurance increased the odds for women (OR 3.08; 95 % CI 1.35-7.04) and taking first-generation antipsychotics versus no antipsychotics increased the odds for men (OR 2.09; 95 % CI 1.26-3.48). These findings suggest there are important differences between women and men readmitted to an inpatient psychiatric facility. Future strategies need to take into account gender-specific risk factors in order to improve long-term patient outcomes.

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Section: Discussionmentioning

confidence: 95%

Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences?

Rieke

McGeary

Schmid

et al. 2015

Community Ment Health J

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“…The rates of clozapine prescription for TRS patients found in Brazilian community centers were similar to rates found in studies carried out in the United States 28,29 , an especially low proportion when compared to other countries 26,27,30 . Clozapine was only prescribed for 22 individuals, which represents 21.4% of the TRS patients, or 5% of the total number of schizophrenia patients, despite the abundant evidence of clozapine's superior efficacy and effectiveness compared with other antipsychotic drugs in the treatment of TRS patients 6,7,8,13,31,32 . Current clinical practice guidelines for the treatment of schizophrenia recommend that a trial of clozapine should be offered after the identification of resistance to antipsychotic treatment 1,15,33,34 , which suggests that the major part of the psychiatrists participating in our study do not follow strictly to guideline recommendations, a feature also observed in other parts of the world 22,35 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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Background: Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective: To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods: A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients' clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results: Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion: As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

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“…Patients discharged on clozapine are less likely to be readmitted to hospital [4]; in addition, clozapine is the antipsychotic drug with the lowest rates of discontinuation and switching [5] and is the least likely to require combination with other antipsychotic medications [6]. …”

Section: Introductionmentioning

confidence: 99%

Clozapine Prescribing in a Canadian Outpatient Population

et al. 2013

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ObjectiveDescription of demographics of an outpatient population of clozapine users. MethodsRetrospective chart review study of an urban population diagnosed with schizophrenia. Assessment of therapeutic histories in relation to clinical practice guidelines. ResultsSeventy-seven of the 467 patients were on clozapine therapy. Average patients’ age was 39.4 ± 11.8 years) and 68% were males. The majority of patients (68%) had tried 3 or more antipsychotics before switching to clozapine, 21% had tried two and 11% had tried one. Median length of therapy prior to clozapine initiation was 8.9 years in males and 7.7 years in females. ConclusionUntil 2010, the use of clozapine was often delayed and more than 2 antipsychotic medications were tried for relatively long periods of time before patients were switched to this effective agent.

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Time to rehospitalization in patients with schizophrenia discharged on first generation antipsychotics, non-clozapine second generation antipsychotics, or clozapine

Cited by 28 publications

References 19 publications

Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences?

Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences?

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Clozapine Prescribing in a Canadian Outpatient Population

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