scholarly journals Clozapine treatment and risk of COVID-19 infection: retrospective cohort study

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Risha Govind ◽  
Daniela Fonseca de Freitas ◽  
Megan Pritchard ◽  
Richard D. Hayes ◽  
James H. MacCabe
Keyword(s):  
Service Use ◽  
Smoking Status ◽  
Antipsychotic Treatment ◽  
Schizophrenia Spectrum Disorders ◽  
Clozapine Treatment ◽  
Susceptibility To Infection ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Spectrum Disorders ◽  
Clinical Records

Background Clozapine, an antipsychotic with unique efficacy in treatment-resistant psychosis, is associated with increased susceptibility to infection, including pneumonia. Aims To investigate associations between clozapine treatment and increased risk of COVID-19 infection in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications in a geographically defined population in London, UK. Method Using information from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 6309 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders and were taking antipsychotics at the time of the COVID-19 pandemic onset in the UK. People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, body mass index (BMI), smoking status and SLAM service use. Results Of 6309 participants, 102 tested positive for COVID-19. Individuals who were on clozapine had increased risk of COVID-19 infection compared with those who were on other antipsychotic medication (unadjusted hazard ratio HR = 2.62, 95% CI 1.73–3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted HR = 1.76, 95% CI 1.14–2.72). Conclusions These findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19 infection. Further research will be needed in other samples to confirm this association. Potential clinical implications are discussed.

scholarly journals Clozapine treatment and risk of COVID-19

2020 ◽  
Author(s):  
Risha Govind ◽  
Daniela Fonseca de Freitas ◽  
Megan Pritchard ◽  
Richard D. Hayes ◽  
James H. MacCabe
Keyword(s):  
Service Use ◽  
Smoking Status ◽  
Antipsychotic Treatment ◽  
Schizophrenia Spectrum Disorders ◽  
Clozapine Treatment ◽  
Susceptibility To Infection ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Spectrum Disorders ◽  
Clinical Records

ABSTRACTBackgroundClozapine, an antipsychotic with unique efficacy in treatment resistant psychosis, is associated with increased susceptibility to infection, including pneumonia.AimsTo investigate associations between clozapine treatment and increased risk of COVID-19 in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications, using electronic health records data, in a geographically defined population in London.MethodUsing information from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 6,309 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders and were taking antipsychotics at the time on the COVID-19 pandemic onset in the UK. People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, BMI, smoking status, and SLAM service use.ResultsOf 6,309 patients, 102 tested positive for COVID-19. Individuals who were on clozapine had increased risk of COVID-19 compared with those who were on other antipsychotic medication (unadjusted HR = 2.62 (95% CI 1.73 - 3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted hazard ratio HR=1.76, 95% CI 1.14 - 2.72).ConclusionsThese findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19. Further research will be needed in other samples to confirm this association. Potential clinical implications are discussed.

scholarly journals Outcomes of COVID-19 infection in patients treated with Clozapine.

2021 ◽  
Author(s):  
Risha Govind ◽  
Daniela Fonseca de Freitas ◽  
Megan Pritchard ◽  
Mizanur Khondoker ◽  
James T Teo ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Treatment ◽  
Schizophrenia Spectrum Disorders ◽  
Clozapine Treatment ◽  
Care Treatment ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Related Hospitalisation ◽  
Spectrum Disorders ◽  
Clinical Records

Background Clozapine, an antipsychotic, is associated with increased susceptibility to infection with COVID-19, compared to other antipsychotics. Aims To investigate associations between clozapine treatment and increased risk of adverse outcomes of COVID-19, namely COVID-related hospitalisation and intensive care treatment, and death, among patients taking antipsychotics with schizophrenia-spectrum disorders. Method Using data from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 157 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders, were taking antipsychotics at the time of the COVID-19 pandemic in the UK, and had a laboratory-confirmed COVID-19 infection. The following health outcomes were measured: COVID-related hospitalisation, COVID-related intensive care treatment death. We tested associations between clozapine treatment and each outcome using logistic regression models, adjusting for gender, age, ethnicity, neighbourhood deprivation, obesity, smoking status, diabetes, asthma, bronchitis and hypertension using propensity scores. Results In the 157 individuals who developed COVID while on antipsychotics, there were 44 COVID-related hospitalisations, 13 COVID-related intensive care treatments and 13 deaths of any cause during the follow-up period. In the unadjusted analysis, there was no significant association between clozapine and any of the outcomes and there remained no associations following adjusting for the confounding variables. Conclusions In our sample of patients with COVID-19 and schizophrenia-spectrum disorders, we found no evidence that clozapine treatment puts patients at increased risk of hospitalisation, intensive care treatment or death, compared to any other antipsychotic treatment. However, further research should be considered in larger samples to confirm this.

Living conditions of patients with schizophrenia spectrum disorders in the region of ‘Tâmega e Sousa’ (Portugal)

2020 ◽  
pp. 002076402096253
Author(s):  
Rui Barranha ◽  
Tânia Teixeira ◽  
João Quarenta ◽  
Orlando von Doellinger
Keyword(s):  
Observational Study ◽  
Psychiatric Disorders ◽  
Social Exclusion ◽  
Market Integration ◽  
Professional Status ◽  
Schizophrenia Spectrum Disorders ◽  
Cross Sectional ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders ◽  
Clinical Records

Background: Schizophrenia spectrum disorders (SSD) are the most impairing psychiatric disorders and are a major cause of social exclusion. Despite that, there are only two studies published assessing the socioeconomic characteristics of SSD patients living in Portugal. Aims: The purpose of this study is to assess the degree of social and family support for SSD patients living in the region of ‘Tâmega e Sousa’, in northern Portugal. Method: We conducted a cross-sectional observational study using patients under home-based care provided by the Department of Psychiatry and Mental Health of Centro Hospitalar do Tâmega e Sousa. We retrieved sociodemographic data from clinical records. The study was approved by the Hospital Ethics Committee. Results: Our sample consists on 67 patients with SSD, mostly men (74.6%). Although the majority was single (69.2%) and childless (85.7%), only a minority lived alone (21.2%). In relation to their professional status, only 5.0% were employed and 78.3% got a disability pension. Among the patients that lived accompanied, 68% lived with their parents or grandparents, and a quarter lived with family members affected by psychiatric disorders. Conclusions: These findings highlight the dependence of SSD patients on their family’s support. Lack of labour market integration, economic dependence and difficulty establishing stable relationships further aggravate their social exclusion. Although our results are consistent with a previous observational study held in Portugal, our patients display a worse functional status. Even considering the possible patient selection bias, there is evidence supporting the need for more investment in psychosocial rehabilitation that should take into account the sociodemographic idiosyncrasies of this Portuguese region.

scholarly journals Increased Risk of Parkinson's Disease in Patients With Schizophrenia Spectrum Disorders

2021 ◽  
Author(s):  
Tomi Kuusimäki ◽  
Haidar Al‐Abdulrasul ◽  
Samu Kurki ◽  
Jarmo Hietala ◽  
Sirpa Hartikainen ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Spectrum Disorders

scholarly journals Demographic and clinical variables associated with response to clozapine in schizophrenia: a systematic review and meta-analysis

2021 ◽  
Vol 51 (3) ◽  
pp. 376-386
Author(s):  
Kira Griffiths ◽  
Edward Millgate ◽  
Alice Egerton ◽  
James H. MacCabe
Keyword(s):  
Meta Analysis ◽  
Schizophrenia Spectrum Disorders ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Clozapine Treatment ◽  
Duration Of Illness ◽  
Schizophrenia Spectrum ◽  
Younger Age ◽  
Clozapine Response ◽  
Spectrum Disorders

AbstractClozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia. However, response to clozapine is variable. Understanding the demographic and clinical features associated with response to clozapine may be useful for patient stratification for clinical trials or for identifying patients for earlier initiation of clozapine. We systematically reviewed the literature to investigate clinical and demographic factors associated with variation in clozapine response in treatment-resistant patients with schizophrenia spectrum disorders. Subsequently, we performed a random-effects meta-analysis to evaluate differences in duration of illness, age at clozapine initiation, age of illness onset, body weight and years of education between clozapine responders and non-responders. Thirty-one articles were eligible for qualitative review and 17 of these were quantitatively reviewed. Shorter duration of illness, later illness onset, younger age at clozapine initiation, fewer hospitalisations and fewer antipsychotic trials prior to clozapine initiation showed a trend to be significantly associated with a better response to clozapine. Meta-analysis of seven studies, totalling 313 subjects, found that clozapine responders had a significantly shorter duration of illness compared to clozapine non-responders [g = 0.31; 95% confidence interval (CI) 0.06–0.56; p = 0.01]. The results imply that a delay in clozapine treatment may result in a poorer response and that a focus on prompt treatment with clozapine is warranted.

scholarly journals CLINICAL AND SOCIAL FACTORS ASSOCIATED WITH VIOLENT BEHAVIOR IN PERSONS WITH SCHIZOPHRENIA SPECTRUM DISORDERS

2021 ◽  
Vol 9 (11) ◽  
pp. 775-780
Author(s):  
Nana Zavradashvili MD ◽  
◽  
Otar Toidze MD , PhD ◽  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Violent Behavior ◽  
Living Environment ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Increased Risk ◽  
Violent Acts ◽  
Spectrum Disorders ◽  
Persons With Schizophrenia

Study of the relationship between mental disorder and violent behavior is critical both from a public health perspective and for the proper planning and development of mental health services.However, the complex contribution of clinical, historical and environmental risk factors for violence in persons with schizophrenia remains unclear. The aim of the study was to identify clinical and social risk factors for violence in patients with schizophrenia and schizophrenia spectrum disorders (SSD) using a case-control design. Cases were defined as patients with SSD who had committed at least one act of offence in the past (94 patients wereenrolled from forensic psychiatricward). Controls were genderand age matched patients with SSD who had never committed violent acts (106 patients from general psychiatric services).A standard set of instruments was used to assess patients exposure to a variety of risk factors. Data were collected through patient interviews and medical records.Study results showed, that increased risk of violence was associated with severity of positive psychotic symptoms, diagnosis of delusional disorder, irregular or no contacts with mental health services. Significant risk factors for serious violent acts were associated with comorbid alcohol misuse, impulsivity,persecutory delusions,decreased emotional responseand unsatisfactory living environment. Study confirmed that the interaction of social andclinicalfactorswith treatment related factors played an important role as determinants of violence. These factors should be the focus of treatment and management of patients with SSD to prevent violent behavior.

scholarly journals T216. VARIATION IN SIDE EFFECTS TO ANTIPSYCHOTIC TREATMENT ACROSS SCHIZOPHRENIA SPECTRUM DISORDERS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S314-S315
Author(s):  
Maria Susanne Neumeier ◽  
Stephanie Winkelbeiner ◽  
John Kane ◽  
Erich Seifritz ◽  
Maximilian Huhn ◽  
...  
Keyword(s):  
Weight Gain ◽  
Side Effects ◽  
Adverse Effects ◽  
Precision Medicine ◽  
Antipsychotic Treatment ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Second Generation Antipsychotics ◽  
Spectrum Disorders ◽  
The Right

Abstract Background Adverse effects of antipsychotic drugs play a key role in non-compliance and discontinuation of treatment in Schizophrenia Spectrum Disorders (SSD). Precision medicine aims to minimize such adverse effects by selecting the right treatment for the right patients. To determine the need for precision medicine we need to estimate the amount of variation in adverse effects between patients. While clinical experience suggests that such variation is considerable, analyzing how variation differs between treated and untreated patients can answer this question. Here, we hypothesized to find larger variation in treatment compared to control groups of patients treated with second generation antipsychotics. Methods We included double-blind, placebo-controlled, randomized trials of adults with a diagnosis of schizophrenia spectrum disorders and prescription for licensed antipsychotic drugs. Means and variances of the pretreatment and posttreatment outcome differences of weight gain, prolactine levels, and corrected QTC times were extracted. Data quality and validity were ensured by following the PRISMA guidelines. The outcome measure was the overall variability ratio of treatment to control across RCTs. Individual variability ratios were weighted by the inverse-variance method and entered into a random-effects model. Results We included N = 13 282 patients for weight gain, N = 11 767 for prolactine levels, and N = 7 203 for QTC time. For all the measured adverse effects, variances were greater in treatment compared to control. Specifically, variance ratios were increased for weight gain (VR = 1.13, 95% CI: 1.06, 1.20), prolactine levels (VR = 1.38, 95% CI: 1.13, 1.68) and QTc time (VR = 1.06, 95% CI: 1.01, 1.12). Discussion We found increased variability in the major side effects that patients with SSD had under treatment with second generation antipsychotics. Indeed, some patients were more susceptible than others to weight gain, prolactine level increase, and QTC time increase, suggesting that precision medicine in antipsychotic treatment should be informed by individual differences in side effects rather than treatment effects. Future studies should aim at finding biological predictors of such individual differences in side effects.

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