Ensuring care for clozapine-treated schizophrenia patients during the COVID-19 pandemic

Nichols, James Hastings; Gannon, Jessica; Conlogue, Judith; Sarpal, Deepak; Montgomery, Jamie L.; Sherwood, Robin; Fabian, Tanya J.; Ballough, Juliette R.; Fredrick, Noreen; Chengappa, K. N. Roy

doi:10.1016/j.schres.2020.05.053

Cited by 15 publications

(14 citation statements)

References 6 publications

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“…Supplementary Table 1 available at provides a summary of characteristics of the included studies in this review. 2,4-50…”

Section: Resultsmentioning

confidence: 99%

“…Nichols et al 18 reported on changes implemented in their clozapine clinic, which serves 184 patients, during the pandemic. They shifted in-person nursing assessments to telepsychiatry visits, started to deliver clozapine for curb-side pick-up or through the mail, and implemented blood work exemptions (up to 3 months) as per USA Food and Drug Administration recommendations.…”

Section: Resultsmentioning

confidence: 99%

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Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review

Zhand

Joober

2021

BJPsych open

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Background COVID-19 was declared a pandemic in March 2020, by the World Health Organization. The pandemic has had unprecedented worldwide implications, in particular on marginalized populations. Aims The aim of this study is to review the impact of the pandemic on patients with schizophrenia spectrum disorders. Method A number of databases were searched for this review, including PubMed, EMBASE, PsycINFO and Google Scholar. Search terms included psychosis and COVID-19, schizophrenia and COVID-19, and severe mental illness and COVID-19. We included all English language papers and preprints. The final search was done on 15 July 2020. Results Forty-seven relevant studies were identified and included in this review. Studies were summarised into five main subcategories: potential impact of the COVID-19 pandemic on physical health outcomes of patients with schizophrenia spectrum disorders, impact on mental health outcomes, review of case reports and case series to date, treatment recommendation guidelines and risk of increased prevalence of psychosis. Conclusions Patients with schizophrenia spectrum disorders may be vulnerable to the effects of the COVID-19 pandemic. This patient population has a number of risk factors, including psychosocial adversities and illness related factors. Continuous monitoring and long-term studies of the impact of the pandemic on this patient population are required.

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“…Supplementary Table 1 available at provides a summary of characteristics of the included studies in this review. 2,4-50…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review

Zhand

Joober

2021

BJPsych open

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“…Some patients with psychosis face healthcare inequalities relating to a lack of a sense of self-protection and difficulty adhering to selfisolation guidelines [95]. The importance of safeguarding access to clozapine monitoring clinics and depot antipsychotic injections for patients with chronic schizophrenia has been highlighted by the psychiatric profession [96]. While there are currently no data on the COVID-19 in clozapine-treated patients, clinicians should be vigilant for signs of infection in these patients [97].…”

Section: Patients With Mental Health Disordersmentioning

confidence: 99%

COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Flaherty

Hession

Liew

et al. 2020

Trop Dis Travel Med Vaccines

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Background: A high burden of severe disease and death from the coronavirus disease 2019 (COVID-19) has been consistently observed in older patients, especially those with pre-existing medical co-morbidities. The global pandemic lockdown has isolated many patients with chronic illnesses from their routine medical care. This narrative review article analyses the multitude of issues faced by individuals with underlying medical conditions during the COVID-19 pandemic. Methods: Sources for this publication were identified through searches of PubMed for articles published between 31st December 2019 and 4th June 2020, using combinations of search terms. Guidelines and updates from reputable agencies were also consulted. Only articles published in the English language were included. Results: The volume of literature on COVID-19 continues to expand, with 17,845 articles indexed on PubMed by 4th June 2020, 130 of which were deemed particularly relevant to the subject matter of this review. Older patients are more likely to progress to severe COVID-19 disease requiring intensive care unit (ICU) admission. Patients with preexisting cardiovascular disease, especially hypertension and coronary heart disease, are at greatly increased risk of developing severe and fatal COVID-19 disease. A controversial aspect of the management of COVID-19 disease has been the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Obese COVID-19 patients are more likely to require complex ICU management. Putative mechanisms of increased COVID-19 disease severity in diabetes include hyperglycaemia, altered immune function, sub-optimal glycaemic control during hospitalisation, a pro-thrombotic and pro-inflammatory state. Patients with mental health disorders are particularly vulnerable to social isolation, and this has been compounded by the suspension of non-emergency care in hospitals around the world, making it difficult for patients with chronic mental illness to attend outpatient appointments.

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“…Clozapine is amongst the most effective antipsychotics used for treatment-resistant schizophrenia ( Huhn et al, 2019 ). Clozapine remains significantly underutilized, in part due to frequent blood tests requiring regular absolute neutrophil count (ANC) monitoring ( Nichols et al, 2020 ). Adverse reactions to clozapine include neutropenia (2.7% of patients) which can prefigure an impending life-threatening agranulocytosis, (0.4% of patients) ( Atkin et al, 1996 ; Gee and Taylor , 2020; Pandarakalam, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report

Bonaccorso¹,

Ricciardi²,

Ouabbou³

et al. 2021

Brain, Behavior, & Immunity - Health

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Ensuring care for clozapine-treated schizophrenia patients during the COVID-19 pandemic

Cited by 15 publications

References 6 publications

Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review

Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review

COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report

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