Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002–2012)

Li, Qian; Xiang, Yu‐Tao; Su, Yun‐Ai; Shen, Liang; Yu, Xin; Correll, Christoph U.; Ungvári, Gábor S.; Chiu, Helen F.K.; Ma, Chao; Wang, Gaohua; Bai, Pei-Shen; Li, Tao; Sun, Lu; Shi, Jiannong; Xiansheng, Chen; Mei, Qiyi; Li, Keqing; Si, Tianmei; Kane, John M.

doi:10.1016/j.schres.2015.07.048

Cited by 19 publications

(24 citation statements)

References 47 publications

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“…In 2002, 28% of all patients were prescribed clozapine in a hospital in Beijing, while this number was 62% in a less developed district [23]. In more recent years, rates of clozapine use across the country have decreased, but were still as high as 26.4% in 2012 [24]. In our study population, 34% did not permanently reside in Beijing, and 29% were from rural communities.…”

Section: Trends In Medicationmentioning

confidence: 62%

Predictors of outcome in early onset schizophrenia: a 10-year follow-up study

Guo

Cao

et al. 2020

BMC Psychiatry

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Background: Younger age at onset is generally thought to be a predictor of poor outcome in Early Onset Schizophrenia (EOS), but there is a paucity of epidemiological data supporting this belief. This study aims to describe long-term outcomes and predictors of patient functioning in EOS, with a focus on the effect of age at onset. Methods: We consecutively enrolled 118 EOS patients who were hospitalized in 2006. Mean age at baseline was 13.3 ± 2.3 years. Sixty-five subjects were successfully interviewed. Mean length of follow up was 10.4 ± 0.3 years. Baseline data were collected from inpatient medical records, while follow up was conducted primarily through telephone interviews of patient relatives. WHODAS 2.0 was used to measure global functioning at follow up. Outcomes included education, employment, marriage status, physical health, subsequent diagnoses and treatment, and patient functioning. Univariate and multivariate regression models were used to assess predictors of outcome, while propensity scores were used to adjust for confounding in analyzing the effect of age at onset on functional outcome. Results: Of the 65 subjects where follow-up data were available, 3 were deceased at follow up. Five (8%) discontinued treatment. Diagnostic stability was 76%. Nearly a quarter (24%) were using clozapine at follow up. In male and female patients, 61 and 55% respectively were overweight, while 29 and 32% respectively were obese. Sixteen (26%) were economically self-sufficient, while 34 (55%) were unemployed. Thirteen (21%) patients had ever been married. The median WHODAS score was 15 (IQR 2 to 35), roughly corresponding to the 78th percentile on population norms. Extroverted personality (p = 0.01), suspicious personality (p = 0.02), and high level of education (p = 0.001) predicted better functioning. Age of onset was not associated with function in either the univariate model (p = 0.24), full model (p = 0.17) or the final risk factor model (p = 0.11), nor after using propensity scores to further adjust for confounders. Conclusion: The long-term functional outcome of EOS is more optimistic than generally believed. Age at disease onset does not predict long-term functional outcome in EOS populations.

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Section: Trends In Medicationmentioning

confidence: 62%

Predictors of outcome in early onset schizophrenia: a 10-year follow-up study

Guo

Cao

et al. 2020

BMC Psychiatry

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“…Clozapine is the most efficacious antipsychotic drug for this population [ 2 , 3 ], but many patients cannot tolerate clozapine due to its adverse drug reactions (ADRs) [ 3 , 4 ]. Apart from agranulocytosis, clozapine may cause sedation, constipation, and/or an increased the risk of metabolic syndrome, thereby lowering treatment adherence [ 5 – 7 ]. Augmenting strategies, such as antipsychotic polypharmacy, adjunctive use of antidepressants, mood stabilizers, fatty acid supplements, glutamatergic agents and electroconvulsive therapy (ECT) [ 8 – 10 ], have been considered for TRS.…”

Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials

et al. 2016

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This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I2 = 62%), separating the two groups as early as weeks 1–2 with an SMD of -0.58 (p<0.00001; I2 = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4–9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6–16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4–11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2–5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache.Trial registrationCRD42014006689 (PROSPERO).

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“…Female patients and patients with longer DOT were more resistant to the effect of clozapine. This result indicated the beneficial effect of clozapine on AVHs [14-16], particularly on subjective dimension.…”

Section: Discussionmentioning

confidence: 84%

Long-Term Changes in Self-Report Auditory Verbal Hallucinations in Patients with Schizophrenia Using Clozapine

Chung

Jeong

Jung

et al. 2019

Psychiatry Investig

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This study explored long-term changes in self-report auditory verbal hallucinations (AVHs) among patients with schizophrenia taking clozapine. Forty-four patients who were evaluated more than twice and were above the mild severity category on the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) were enrolled. The mean observation period was 492.5±350.1 days (median, 452 days). The mean total, physical, and emotional factor scores on the HPSVQ were significantly reduced from baseline to the final observations except for one item “interference with life,” which was not significantly reduced. Regarding the time-dependent longitudinal changes modeled using linear mixed-effect regression, the total and physical factor scores showed significant changes during the first year, but the emotional factor score did not satisfy a more stringent level of significance. Female gender was negatively associated with the reduction in total and physical factor scores. The duration of treatment with clozapine also had a negative relationship with the reductions in all three scores.

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Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002–2012)

Cited by 19 publications

References 47 publications

Predictors of outcome in early onset schizophrenia: a 10-year follow-up study

Predictors of outcome in early onset schizophrenia: a 10-year follow-up study

Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials

Long-Term Changes in Self-Report Auditory Verbal Hallucinations in Patients with Schizophrenia Using Clozapine

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