A systematic review on the use of clozapine in treatment of tardive dyskinesia and tardive dystonia in patients with psychiatric disorders

Wong, John Chee Meng; Pang, Tiffanie Sze Wing; Cheuk, Natalie Kwok Wing; Liao, Yingqi; Bastiampillai, Tarun; Chan, Sherry Kit Wa

doi:10.1007/s00213-022-06241-2

Cited by 9 publications

(7 citation statements)

References 58 publications

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“…One of the key limitations of the study is the use of clozapine as a proxy for TR. Clozapine may be used to alleviate other conditions such as recurrent suicidality [ 41 ] and tardive dyskinesia [ 42 ]. However, over 90% of patients who were prescribed with clozapine were considered to have fulfilled the criteria of TRS [ 1 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator

Wong,

Luo,

Tang

et al. 2024

Transl Psychiatry

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About 15–40% of patients with schizophrenia are treatment resistance (TR) and require clozapine. Identifying individuals who have higher risk of development of TR early in the course of illness is important to provide personalized intervention. A total of 1400 patients with FEP enrolled in the early intervention for psychosis service or receiving the standard psychiatric service between July 1, 1998, and June 30, 2003, for the first time were included. Clozapine prescriptions until June 2015, as a proxy of TR, were obtained. Premorbid information, baseline characteristics, and monthly clinical information were retrieved systematically from the electronic clinical management system (CMS). Training and testing samples were established with random subsampling. An automated machine learning (autoML) approach was used to optimize the ML algorithm and hyperparameters selection to establish four probabilistic classification models (baseline, 12-month, 24-month, and 36-month information) of TR development. This study found 191 FEP patients (13.7%) who had ever been prescribed clozapine over the follow-up periods. The ML pipelines identified with autoML had an area under the receiver operating characteristic curve ranging from 0.676 (baseline information) to 0.774 (36-month information) in predicting future TR. Features of baseline information, including schizophrenia diagnosis and age of onset, and longitudinal clinical information including symptoms variability, relapse, and use of antipsychotics and anticholinergic medications were important predictors and were included in the risk calculator. The risk calculator for future TR development in FEP patients (TRipCal) developed in this study could support the continuous development of data-driven clinical tools to assist personalized interventions to prevent or postpone TR development in the early course of illness and reduce delay in clozapine initiation.

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Section: Discussionmentioning

confidence: 99%

Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator

Wong,

Luo,

Tang

et al. 2024

Transl Psychiatry

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“…Despite clinicians' best intentions, widely used psychiatric treatments can be ineffective, exacerbate symptoms, and lead to undesirable outcomes. [29][30][31][32] Consequently, clinicians are accustomed to discussing many risks associated with psychedelics, such as transient anxiety, nausea, or altered mood. Other risks are much harder to discuss and understand, including acute or chronic perceptual changes, ego dissolution, and mystical experiences characterized by increased feelings of openness and connectedness.…”

Section: Acute and Chronic Perceptual Changesmentioning

confidence: 99%

Essentials of Informed Consent to Psychedelic Medicine

Marks,

Brendel,

Shachar

et al. 2024

JAMA Psychiatry

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ImportanceInterest in administering psychedelic agents as mental health treatment is growing rapidly. As drugmakers invest in developing psychedelic medicines for several psychiatric indications, lawmakers are enacting legal reforms to speed access globally, and health agencies are preparing to approve these treatments. Meanwhile, US states, such as Oregon and Colorado, are making psychedelics available for supervised use outside the conventional health care system.ObservationsDespite legal change and potentially imminent regulatory approval in some countries, standards for integrating psychedelics into health care have lagged, including norms for designing and implementing informed consent processes. Informed consent is complicated by the unique features of psychedelics and their means of administration. Because no governments have approved any classic psychedelics for general medical or psychiatric use, only clinical researchers have obtained informed consent from trial participants. Accordingly, there is an unmet need for informed consent processes tailored to the challenges of administering psychedelics in nonresearch settings.Conclusions and RelevanceAnalysis of the challenges of designing and implementing psychedelic informed consent practices revealed 7 essential components, including the possibility of short- and long-term perceptual disturbances, potential personality changes and altered metaphysical beliefs, the limited role of reassuring physical touch, the potential for patient abuse or coercion, the role and risks of data collection, relevant practitioner disclosures, and interactive patient education and comprehension assessment. Because publicly available informed consent documents for psychedelic clinical trials often overlook or underemphasize these essential elements, sample language and procedures to fill the gap are proposed.

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“…Clozapine shows excellent efficacy in alleviating both positive and negative symptoms, as well as improving social adaptation and occupational functioning [ 6 , 18 , 19 ]. Clozapine can reduce symptoms of tardive dyskinesia [ 20 ] and help prevent suicide [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clozapine shows excellent efficacy in alleviating both positive and negative symptoms, as well as improving social adaptation and occupational functioning. 6,18,19 Clozapine can reduce symptoms of tardive dyskinesia 20 and help prevent suicide. 21 More than 30 years have passed since the introduction of the original clozapine compound, and several generic formulations have been developed in various countries during the past few years.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of the Efficacy and Side Effects of Brand-Name and Generic Clozapine for Long-Term Maintenance Treatment Among Korean Patients With Schizophrenia: A Retrospective Naturalistic Mirror-Image Study

Kang,

Yoon,

Kim

et al. 2024

Psychiatry Investig

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Objective Clozapine is considered the most reliable drug for treatment-resistant schizophrenia. In 2014, a generic formulation of clozapine (Clzapine) was introduced in Korea. This study was performed to provide clinical information regarding the use of clozapine and to compare efficacy and tolerability when converting from the brand-name formulation (Clozaril) to the generic formulation during longterm maintenance treatment among Korean patients with schizophrenia.Methods This mirror-image study retrospectively investigated the electronic medical records of patients who had switched from Clozaril to Clzapine with a ≥1-year duration for each formulation. Clinical data were collected, including information regarding clozapine use, psychiatric hospitalization, co-medications, and blood test findings. Data before and after the switch were compared using paired t-tests.Results Among 332 patients, the mean 1-year dosages were 233.32±149.35 mg/day for Clozaril and 217.36±136.66 mg/day for Clzapine. The mean clozapine concentration-to-dose ratios were similar before and after the switch (Clozaril, 1.33±0.68; Clzapine, 1.26±0.80). Switching from Clozaril to Clzapine resulted in no significant differences in the hospitalization rate, hospitalization duration, or laboratory findings (liver function parameters, serum cholesterol level, and serum glucose level). Equivalent doses of co-prescribed antidepressants were decreased, but concomitant medications otherwise showed no significant differences.Conclusion Clinical efficacy and tolerability appear comparable when switching to Clzapine during clozapine maintenance treatment. This study offers descriptive real-world clinical insights into clozapine maintenance treatment in Korea, thereby providing patients with more treatment options and contributing to the development of maintenance guidelines tailored to the Korean population.

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A systematic review on the use of clozapine in treatment of tardive dyskinesia and tardive dystonia in patients with psychiatric disorders

Cited by 9 publications

References 58 publications

Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator

Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator

Essentials of Informed Consent to Psychedelic Medicine

Comparative Study of the Efficacy and Side Effects of Brand-Name and Generic Clozapine for Long-Term Maintenance Treatment Among Korean Patients With Schizophrenia: A Retrospective Naturalistic Mirror-Image Study

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