scholarly journals Clozapine discontinuation in early schizophrenia: a retrospective case note review of patients under an early intervention service

2017 ◽  
Vol 8 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Andrew Shaker ◽  
Rowena Jones
Keyword(s):  
Early Intervention ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Case Note ◽  
Home Treatment ◽  
Early Intervention Service ◽  
Treatment Resistant ◽  
Intervention Service ◽  
The Impact ◽  
Case Note Review

Aim: Research in patients with treatment-resistant schizophrenia has demonstrated that clozapine discontinuation is associated with poor outcomes. There is, however, a paucity of research investigating the impact of clozapine discontinuation specifically in younger patients with more recent onset schizophrenia. A case note review was therefore conducted to ascertain medium-term prognoses in patients with treatment-resistant schizophrenia under an early intervention service (EIS) following clozapine discontinuation. Methods: The case notes of 25 patients under the care of Birmingham EIS who discontinued clozapine were examined retrospectively. Reasons for discontinuation were recorded. Clinical outcomes including total duration of inpatient or home treatment admission, antipsychotic dose, number of alternative antipsychotics prescribed and adverse events were recorded for both the year before and the year after stopping clozapine. Statistical comparisons of pre- and post-discontinuation clinical outcomes determined whether discontinuation had negative effects. Results: There was no significant difference between the pre- and post-discontinuation clinical status following clozapine discontinuation. More than half (56%) of patients remained stable after stopping clozapine. Mean inpatient or home treatment stay rose from 29.7 to 62.6 days ( p = 0.155), total antipsychotic dose from 50.1% of British National Formulary (BNF) limits to 60.5% ( p = 0.627), number of alternative antipsychotics prescribed from 1.28 to 1.80 ( p = 0.186), number of hospital/home treatment episodes from 0.20 to 0.44 ( p = 0.083) and number of adverse events from 0 to 0.20 ( p = 0.059). Non-compliance was the main reason for discontinuation (44%, n = 11). Conclusions: This is the first clozapine discontinuation study specifically considering EIS patients. Discontinuation did not lead to significant effects on 1 year outcomes, though the study is underpowered. These findings may be used to inform future prospective cohort discontinuation studies.

scholarly journals M114. DELUSIONAL CONTENT AT INITIAL PRESENTATION TO A CATCHMENT-BASED EARLY INTERVENTION SERVICE FOR PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S178-S178
Author(s):  
Ann-Catherine Lemonde ◽  
Ridha Joober ◽  
Ashok Malla ◽  
Srividya Iyer ◽  
Martin Lepage ◽  
...  
Keyword(s):  
Early Intervention ◽  
Representative Sample ◽  
Clinical Samples ◽  
First Episode ◽  
Psychotic Episode ◽  
Detailed Knowledge ◽  
Service Users ◽  
Early Intervention Service ◽  
Clinical Variables ◽  
Intervention Service

Abstract Background During a psychotic episode, patients frequently suffer from severe maladaptive beliefs known as delusions. Despite the abundant literature investigating the simple presence or absence of these beliefs, there exists little detailed knowledge regarding their actual content and severity at the onset of illness. Investigating delusions in early clinical samples is critical, because their relatively young, treatment-naïve presentations are less likely to be confounded by the effects of long-term illness or previous interventions. Furthermore, a more detailed view of the association between clinical factors and delusion severity, both globally and per theme, in a larger and more representative sample may improve psychological models and ultimately treatment options. This study reports on delusions during the initiation of indicated treatment for a first episode psychosis (FEP). Methods Data were systematically collected from a sample of 637 service users entering an early intervention service for FEP. The FEP service provides a comprehensive standardized assessment battery with longitudinal follow-up for two years of treatment. The average severity and frequency of each delusional theme at baseline was reported using the Scale for Assessment of Positive Symptoms. Delusional severity, both globally and per theme, was examined across a number of sociodemographic and clinical variables. Results Delusions of a moderate severity or higher were present in the vast majority of individuals experiencing onset of a FEP (94.0%), with persecutory (77.7%), reference (65.5%), and grandiose (40.2%) being the most common themes. Eighty-one percent of service users presented with two or more delusion themes. Persecutory delusions remained consistent in severity across diagnoses, but were more severe with older age of onset (r = .144). No meaningful differences in delusional severity were observed across sex, affective versus non-affective psychosis, or presence/absence of substance abuse or dependence. Global delusion severity was associated with anxiety (r = .205) but not with depression (r = .052), with specific relationships emerging per theme. Delusions commonly referred to as passivity experiences and/or thought alienation, mind reading delusions (r = .242) and delusions of control (r = .247), were related to hallucinatory experiences. We will also examine delusions longitudinally by investigating their relationship to the duration of untreated psychosis and outcomes, along with the stability of delusional content across episodes. Discussion Unlike the more selected samples, confounded treatment effects, and/or varying levels of chronicity seen in previous reports, this community representative sample offers a rare clinical lens into the severity and content of delusions in FEP. While delusional severity remained consistent across certain sociodemographic and clinical variables, this was not always the case. Future work may wish to investigate the evolution of delusions over time, including focusing on specific themes and/or their overlaps, including with smaller samples and in-depth, phenomenologically oriented interviews.

scholarly journals Family‐centred care in early intervention: Examining caregiver perceptions of family‐centred care and early intervention service use intensity

2019 ◽  
Vol 46 (1) ◽  
pp. 1-8
Author(s):  
Beth M. McManus ◽  
Natalie J. Murphy ◽  
Zachary Richardson ◽  
Mary A. Khetani ◽  
Margaret Schenkman ◽  
...  
Keyword(s):  
Early Intervention ◽  
Service Use ◽  
Early Intervention Service ◽  
Intervention Service

Cognitive remediation combined with an early intervention service in first episode psychosis

2014 ◽  
Vol 130 (4) ◽  
pp. 300-310 ◽  
Author(s):  
T. Østergaard Christensen ◽  
L. Vesterager ◽  
G. Krarup ◽  
B. B. Olsen ◽  
M. Melau ◽  
...  
Keyword(s):  
Early Intervention ◽  
Cognitive Remediation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Service ◽  
Intervention Service ◽  
Episode Psychosis
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