Systematic review of the efficacy and tolerability of Clozapine in the treatment of youth with early onset schizophrenia

Schneider, Carolina; Corrigall, Richard; Hayes, D. P.; Kyriakopoulos, Marinos; Frangou, Sophia

doi:10.1016/j.eurpsy.2013.08.001

Cited by 105 publications

(101 citation statements)

References 48 publications

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“…These data are supported by a review covering 16 clinical studies and four case reports (n = 798) with early onset schizophrenia that also linked relevant weight gain to treatment with clozapine with an incidence of 20 --64%. The authors found an association between increased risk and length of exposure [64]. Beduin and de Haan reviewed data on SGAs used off-lable for impulse regulation disorders and found weight gain associated with all SGAs, but more pronounced in children and patients treated with clozapine and olanzapine [65].…”

Section: Weight Gain Due To Clozapinementioning

confidence: 99%

Weight gain and antipsychotics: a drug safety review

Musil

Obermeier²,

Russ

et al. 2014

Expert Opinion on Drug Safety

155

111

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Recently published data still support the hierarchical ranking of SGAs already proposed in previous reviews ranking clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone and sertindole in the middle, and aripiprazole, lurasidone and ziprasidone with the lowest risk. Number needed to harm varied considerably in our meta-analysis. Younger patients and patients with a lower baseline body mass index are most vulnerable. The greatest amount of weight gain occurs within the first weeks of treatment. AIWG occurs in all diagnostic groups and is also common in treatment with first-generation antipsychotics; therefore, awareness of this adverse event is essential for anyone prescribing antipsychotics.

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Section: Weight Gain Due To Clozapinementioning

confidence: 99%

Weight gain and antipsychotics: a drug safety review

Musil

Obermeier²,

Russ

et al. 2014

Expert Opinion on Drug Safety

155

111

View full text Add to dashboard Cite

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“…In fact, 17 (81 %) had tried clozapine at least once during follow-up, significantly more than in the non-ECT group (N = 8, 38.1 %). Clozapine has been reported to be the best option for treatment-resistant SSD in adolescents and seems to be more effective in the long term for this population [4,[36][37][38]. In a previous study, our group found that patients treated with ECT and clozapine had fewer rehospitalizations after 1 year follow-up than patients treated with ECT and other APs [15].…”

Section: Discussionmentioning

confidence: 80%

Long-term effectiveness of electroconvulsive therapy in adolescents with schizophrenia spectrum disorders

Flamarique

Baeza

Serna

et al. 2014

Eur Child Adolesc Psychiatry

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To compare a sample of adolescents with schizophrenia spectrum disorders (SSD) treated with either ECT or antipsychotics (AP) alone at long-term follow-up. Patients diagnosed with SSD (n = 21) treated with ECT due to resistance to AP or catatonia under the age of 18 years (ECT group), were compared to a randomly selected group of patients with SSD treated only with AP (non-ECT group) (n = 21) and matched for age, gender, diagnosis and duration of illness. Baseline data were gathered retrospectively from medical records. Subjects were assessed at follow-up (mean of follow-up period = 5.5 years; range 2-9 years) using several clinical scales such as the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI) and the Global Assessment of Functioning (GAF). Improvement in PANSS positive, negative, general, total and CGI and GAF scores between baseline and follow-up assessment did not differ significantly between groups. At follow-up, no differences were observed for the PANSS negative, CGI and GAF scores between groups, but patients in the ECT group still had higher PANSS total, positive and general scores. ECT treatment followed by AP medication in treatment-resistant SSD or catatonia is at least as effective in the long term as AP alone in non-resistant patients.

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“…However, the anticholinergic/adrenergic effects of these medications may combine to aggravate unwanted side effects of clozapine such as constipation, impaired visual acuity, and urinary retention. Another option is the use of ophthalmologic drops with anticholinergic properties, such as atropine, as a mouthwash, before going to sleep (Schneider et al, 2013). There are also recent findings on the use of atropine drops three times a day for a week, combined with hyoscine (antimuscarinic agent).…”

Section: Hypersalivation (Sialorrhea/drooling)mentioning

confidence: 98%

“…The total dosage administration may be rearranged over the day so that a lower dose is administered at nighttime (Barnes et al, 2012). Another option is restricting fluids before bedtime and avoiding consumption of caffeine, alcohol, and other drinks with diuretic or bladder irritant properties (Barnes et al, 2012;Schneider et al, 2013). Double voiding before bedtime is another option (Schneider et al, 2013).…”

Section: Nocturnal Enuresismentioning

confidence: 99%

“…Another option is restricting fluids before bedtime and avoiding consumption of caffeine, alcohol, and other drinks with diuretic or bladder irritant properties (Barnes et al, 2012;Schneider et al, 2013). Double voiding before bedtime is another option (Schneider et al, 2013). Although there is no recommendation on a specific medication, a variety of agents, such as ephedrine (Fuller et al, 1996), desmopressin (Steingard, 1994;Aronowitz et al, 1995), anticholinergic drugs (Poyurovsky et al, 1996), tricyclic antidepressants (imipramine, amitriptyline) (Aronowitz et al, 1995;Praharaj and Arora, 2007), and add-on aripiprazole (Lee and Kim, 2010), are reported to be effective.…”

Section: Nocturnal Enuresismentioning

confidence: 99%

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Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

Sagy

Weizman

Katz

2014

International Clinical Psychopharmacology

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This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.

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Systematic review of the efficacy and tolerability of Clozapine in the treatment of youth with early onset schizophrenia

Abstract: Available data although limited in terms of number of studies are consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.

Cited by 105 publications

References 48 publications

Weight gain and antipsychotics: a drug safety review

Weight gain and antipsychotics: a drug safety review

Long-term effectiveness of electroconvulsive therapy in adolescents with schizophrenia spectrum disorders

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects

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