Hematological and Cardiometabolic Safety of Clozapine in the Treatment of Very Early Onset Schizophrenia: A Retrospective Chart Review

Midbari, Yael; Ebert, Tanya; Kosov, Ira; Kotler, Moshe; Weizman, Abraham; Ram, Alpana

doi:10.1089/cap.2013.0050

Cited by 12 publications

(7 citation statements)

References 29 publications

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“… 80% female (n = 40), 20% males (n = 10) Inpatient psychiatry service of a general paediatric hospital in North East USA, all receiving treatment for a suicide plan or attempt Not reported Not reported Not reported RCT Tobacco Use, Alcohol Use High rates of tobacco use in a sample of young people receiving treatment for suicidal ideation/attempts. Midbari et al, (2013) [ 52 ] Israel Young people under 13 years hospitalized in a psychiatric ward treated with clozapine or other psychoactive medication 36 Clozapine: 10.4 (2 sd. ); Non-Clozapine 10.1 (1.4 sd.)…”

Section: Resultsmentioning

confidence: 99%

“…Non-fasted lipid and blood related biomarkers were reported across nine studies. Triglycerides were the most commonly reported [ 18 , 19 , 33 , 40 , 44 , 52 , 56 ]. Weighted average triglycerides were 97.7 mg/dL (95% CI 62.26–128.14; N = 161), and pooled prevalence rate of elevated triglycerides was 23.1% (95% CI 9.2–47.3; N = 193).…”

Section: Resultsmentioning

confidence: 99%

“…Weighted average LDL was 97.93 mg/dL (95% CI 91.54–103.24; N = 161). Cholesterol was reported in four studies [ 39 , 40 , 52 , 56 ]. Weighted average cholesterol was 169.81 mg/dL (95% CI 161.73–177.88; N = 112), and pooled prevalence rate of elevated cholesterol (>5 mmol/L) was 9.8% (95% CI 1.2–48.5; N = 116).…”

Section: Resultsmentioning

confidence: 99%

“…In Hulvershorn et al, [ 40 ], 53% had a comorbid medical condition, and in McCloughen et al, [ 50 ] 30% had at least one (59% of which had multiple conditions). Specific physical health conditions included Tachycardia (heart rate > 100 bpm, 27.8%) [ 52 ], diabetes (6.4%) [ 27 ];2%, [ 39 ], hypertension (2%) [ 39 ], and dyslipidaemia (3%) [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

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The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

Carney

Firth

Pedley

et al. 2021

General Hospital Psychiatry

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Objective Serious mental illness is associated with physical health comorbidities, however most research has focused on adults. We aimed to synthesise existing literature on clinical and behavioral cardiometabolic risk factors of young people on mental health inpatient units. Methods A systematic review and meta-analysis was conducted, using electronic searches of PsycINFO, EMBASE, AMED, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE. Eligible studies included child/adolescent mental health inpatient units for <25 years, reporting clinical/behavioral cardiometabolic risk factors. Studies containing adult samples, case-studies, or eating disorder populations were excluded. The main clinical outcome was weight, and main behavioral outcome was tobacco use. Results Thirty-nine studies were identified (n = 809,185). Pooled prevalence rates of young people who were overweight (BMI > 25) was 32.4% (95% CI 26.1%–39.5%; n = 2789), and who were obese (BMI > 30) was 15.5% (95% CI 4.5%–41.6%; n = 2612). Pooled prevalence rates for tobacco use was 51.5% (95% CI 32.2–70.2; N = 804,018). Early signs of metabolic risk were observed; elevated blood cholesterol, presence of physical health conditions, and behavioral risk factors (e.g. physical inactivity). Conclusions This review highlights the vulnerability of young people admitted to inpatient units and emphasises the opportunity to efficiently monitor, treat and intervene to target physical and mental health.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

Carney

Firth

Pedley

et al. 2021

General Hospital Psychiatry

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“…Among the severe psychiatric disorders supporting clozapine, early-onset schizophrenia (EOS) is a rare form of schizophrenia de ned by an onset before the age of 18 with a prevalence < 1/10 000 children in the general population (50).Two systematic reviews of the literature (5,6), have shown the superior e cacy of clozapine in resistant EOS.…”

Section: Discussionmentioning

confidence: 99%

Interest of Fluvoxamine as an Add-on to Clozapine in Children With Severe Psychiatric Disorder According to CYPs Polymorphisms: Experience From a Case Series

BEREL

Mosse

Wils

et al. 2021

Preprint

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BackgroundDespite its drastic efficacy in resistant psychiatric disorders, clozapine remains rarely used in youth due to its side effects. Clozapine plasma level is determined through its metabolism involving several isoforms of cytochromes 450 (CYP450) family. Isoform CYP1A2 appears as a limiting enzyme involved in the metabolism of clozapine while isoforms 2C19, 2D6, 3A4 and 3A5 also contribute in a minor way. Clozapine efficacy is limited by a significant inter-patient variability in exposure according to CYP’s polymorphisms. Clozapine plasma levels may be increased with CYP inhibitors such as fluvoxamine. This drug is a potent enzymatic inhibitor of CYP1A2 and to a lesser extent of CYP3A4 and CYP2D6. Hence, in case of CYPs polymorphisms in youth, the use of fluvoxamine as add on to clozapine could help reaching clinical and biological efficacy and allowing lower clozapine dosage and a better tolerance profile, as it has already been described in adults.Case ReportWe report four pediatric cases with severe psychiatric disorders underlying our experience with CYPs polymorphism explorations and the use of fluvoxamine as add on to clozapine. Our four patients clinically improved after the introduction of fluvoxamine, enhancing clozapine metabolism and therefore clozapine plasma level within therapeutic range. Despite the interesting results of fluvoxamine, we report a severe issue of tolerance for one patient, emphasizing the need for caution regarding possible drugs interactions when fluvoxamine is considered. Hence, we propose a detailed step by step multidisciplinary protocol.ConlusionThe results pointed out the positive clinical effects of fluvoxamine as add-on to clozapine in youth with severe neurodevelopmental disorders but stresses the need for caution regarding drugs interactions.

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Evidence-Based Outcome for the Interventions in Childhood-Onset Schizophrenia

Smirnova

Fountoulakis

2020

Schizophrenia Treatment Outcomes

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Hematological and Cardiometabolic Safety of Clozapine in the Treatment of Very Early Onset Schizophrenia: A Retrospective Chart Review

Cited by 12 publications

References 29 publications

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

Interest of Fluvoxamine as an Add-on to Clozapine in Children With Severe Psychiatric Disorder According to CYPs Polymorphisms: Experience From a Case Series

Evidence-Based Outcome for the Interventions in Childhood-Onset Schizophrenia

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