Reducing restraint with clozapine in involuntarily admitted patients with schizophrenia

IntroductionIn the entire world, restraint and seclusion are common interventions in psychiatric in-patient settings due to aggressive behavior.ObjectivesOur objective was to test for the immediate anti-aggressive property of clozapine compared to other antipsychotic treatments in an enriched cohort with high rates of restraint during early hospitalization.MethodsWe present a retrospective chart review in all involuntary admissions with schizophrenia during 2011–2014 in Psychiatry and Neurology Hospital, Brasov, Romania. Timing and number of restraints in addition to clinical, demographic and treatment characteristics were extracted. Based on our earlier observation of clinical efficacy of early, fast titration of clozapine, we tested the hypothesis that clozapine treatment was associated with reduced use of restraint, and with longer restraint-free periods.ResultsIn 115 patients with schizophrenia (age = 39.7 ± 11.1 years; male = 59%) involuntarily admitted due to externalized (74.78%) or self-directed violence (25.22%), restraint was used in 89.6%; with a median duration of 3 hours until restraint past admission. Antipsychotics used immediately after hospitalization included haloperidol (70.4%), clozapine (11.3%), olanzapine (10.4%) and other second-generation antipsychotics (7.9%). Comparison of restraint characteristics favored immediate clozapine use with highly reduced rates of restraint (38.5% vs.95.6%. P < 0.001) and significantly extended hours until restraint ([118 h,24 h, 426 h] vs.[3 h,0.25 h, 48 h]; median; 25th, 75th percentile; P < 0.001) relative to the remaining cohort. These effects remained highly significant after controlling for potential moderators of restraint use in multivariate models.ConclusionsThese retrospective data suggest an early anti-aggressive effect of clozapine during the immediate use of clozapine in highly problematic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2011 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S544-S544

Author(s):

K. Kulkarni ◽

R. Arasappa ◽

K. Prasad ◽

A. Zutshi ◽

P. Chand ◽

...

Keyword(s):

Chart Review ◽

Second Generation ◽

Treatment Guidelines ◽

Treatment Options ◽

Specific Treatment ◽

Retrospective Chart Review ◽

Delusional Disorder ◽

Response To Treatment ◽

Second Generation Antipsychotics ◽

Competing Interest

IntroductionThere is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.Objectives and aimsWe aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.ResultsA total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).ConclusionOur study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Five-year Course of Bipolar Disorder Following Treatment of First Manic Episode with Risperidone Versus Olanzapine: A Retrospective Review

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2166 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S206-S206

Author(s):

K. Kulkarni ◽

G. Devasthali ◽

A. Purty ◽

M. Kesavan ◽

J. Reddy ◽

...

Keyword(s):

Treatment Guidelines ◽

Retrospective Chart Review ◽

Mood Stabilizer ◽

Manic Episode ◽

Complete Recovery ◽

Mood Stabilizers ◽

First Episode ◽

Second Generation Antipsychotics ◽

Icd 10 ◽

Competing Interest

ObjectiveContemporary treatment guidelines recommend use of second-generation antipsychotics (SGAs) either as mono therapy or in combination with mood stabilizers as first-line treatment. While these drugs have been established to have superior efficacy compared to placebo, there is very less data comparing these antipsychotics with one another. We sought to study differences in the five-year outcome of first episode of mania (FEM) treated with olanzapine or risperidone, either alone or in combination with mood stabilizer.MethodsWe conducted a retrospective chart review of patients diagnosed with FEM (ICD-10) in the year 2008 (n = 88) at our centre. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about time to recovery and recurrence after FEM, total episodes, drug compliance and response, and number of follow-up visits from 2008 to 2013. The study was approved by the Institute Ethics Committee.ResultsA total of 88 patients received diagnosis of FEM in the year 2008, of which 50 (56.8%) received risperidone and 35 (39.8%) received olanzapine. The two groups were comparable in socio-demographic and clinical symptomatology of FEM (all P > 0.08). Complete recovery was significantly more in the olanzapine group than the risperidone group (χ2 = 4.84, P < 0.05).ConclusionOur study indicates that risperidone and olanzapine, either alone or in combination with mood stabilizers have a similar impact on the five-year course of BD following a first manic episode. However, olanzapine is associated with more complete recovery from FEM than risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Examining the clinical utility of neuroimaging on an inpatient psychiatric unit

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1018 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S627-S628

Author(s):

L. Gonzalez ◽

M. Mashayekh ◽

W. Gu ◽

P. Korenis ◽

A. Khadivi

Keyword(s):

Clinical Utility ◽

Chart Review ◽

Clinical Course ◽

Psychiatric Service ◽

Retrospective Chart Review ◽

Psychiatric Setting ◽

Recent Developments ◽

Psychiatric Conditions ◽

Competing Interest ◽

Inpatient Psychiatric Unit

IntroductionRecent developments in neuroimaging have revolutionized medicine and aided in our understanding of how biological abnormalities may contribute to clinical presentation. While such advances have begun to enhance our knowledge about the timing of abnormalities, it remains unclear at this time how neuroimaging impacts the clinical course of the patient. In addition, much debate exists regarding the clinical necessity of neuroimaging for psychiatric conditions, and there are contradictory reports and guidelines for the application of conventional brain imaging (MRI and CT) in the evaluation of patients with mental illness.ObjectiveWe aim to review the clinical utility of neuroimaging in an acute psychiatric setting, and hypothesize that there will be no significant differences between the outcome of neuroimaging and clinical course for patients.MethodWe conducted a retrospective chart review of adult patients who were diagnosed and treated for psychiatric conditions on an inpatient psychiatric service over a period of 36 months July 1, 2013–June 30, 2016.ConclusionsWhile imaging advances have added to our understanding of biological abnormalities and can aid in ruling out organic causes of psychiatric illness, at this time it is not guiding clinical management for patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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COVID-19 infection causes a reduction in neutrophil counts in patients taking clozapine

Journal of Psychiatry and Neuroscience ◽

10.1503/jpn.200208 ◽

2021 ◽

Vol 46 (2) ◽

Author(s):

Siobhan Gee ◽

David Taylor

Keyword(s):

Acute Phase ◽

Plasma Levels ◽

Chart Review ◽

Retrospective Chart Review ◽

White Cell ◽

Clozapine Treatment ◽

Cell Counts ◽

Baseline Levels

Background: Monitoring of white cell counts during clozapine treatment leads to cessation of therapy if levels fall below predetermined values. Reductions in white cell counts, driven by lower levels of lymphocytes, have been observed with coronavirus disease 2019 (COVID-19). Neutropenia during COVID-19 has not been reported. We present data for 56 patients who were taking clozapine and had COVID-19. Methods: We included patients who were taking clozapine at the time they tested positive for COVID-19. We compared absolute neutrophil counts, lymphocyte counts and white cell counts between baseline and the first week of infection, and baseline and the second week of infection. Results: We observed reductions in absolute neutrophil counts (p = 0.005), lymphocyte counts (p = 0.003) and white cell counts (p < 0.001) between baseline and the first 7 days of COVID-19. All cell counts had returned to baseline levels by days 8 to 14. Six patients experienced neutropenia (absolute neutrophil counts < 2.0 × 109/L) and of those, 4 underwent mandatory cessation of clozapine. For 3 patients, clozapine treatment had been established for more than 6 months with no previous neutropenia, neutrophil levels returned to baseline within 2 weeks and no further neutropenia was observed on restarting treatment. Limitations: This was a retrospective chart review; larger cohorts are required. Clozapine plasma levels were largely not measured by clinicians. Conclusion: These data strongly suggest that mild neutropenia in the acute phase of COVID-19 in patients who are well established on clozapine is more likely to be a consequence of the virus than of clozapine treatment.

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