Dr. Simon Bow presented a research poster at the The Canadian Psychiatric Association’s 68th Annual Conference, September 27-29, 2018 in Toronto, and Dr Randall White presented it at the American Psychiatric Association Institute on Psychiatric Services, October 4-7, 2018 in Chicago. Here is the research represented on the poster:
Background: Clozapine is the gold standard for managing treatment-resistant psychosis (TRP). Despite superior efficacy, some patients do not tolerate or stop it, and research on this population is scarce. Here we describe inpatients with TRP, treated at the British Columbia Psychosis Program (BCPP) from 2012 to 2017, who required alternative interventions to clozapine.
In a retrospective analysis of 275 patient records, 78 with TRP were not receiving clozapine at discharge. Data collected included demographics, standardized ratings (Positive and Negative Syndrome Scale [PANSS], Social and Occupational Functioning Assessment Scale [SOFAS], Gut and Psychology Syndrome [GAPS], Clinical Global Impression [CGI]), comorbidities, reasons for clozapine discontinuation, and alternative treatments.
A total of 85% of patients had previously taken clozapine; the remainder were not offered or refused it. Reasons patients could not have a clozapine trial at BCPP included a history of myocarditis (13%), agranulocytosis (5%) or neutropenia (8%), refusal (18%), poor compliance (12%), poor response (6%), or other severe side effects [JT1]. Antipsychotics at discharge included oral monotherapy (40%), injectable monotherapy (15%), oral polypharmacy (19%), or oral-injectable combination (23%). Additional medications included mood stabilizers (45%), antidepressants (26%), and/or sedative hypnotics (26%). Electroconvulsive therapy (ECT) was used in 13%. Psychotherapy showed benefit in 17%. Mean PANSS total score reduction was 18% and CGI scale score reduction, 1.3, with 32% and 5% of patients achieving response and remission, respectively.
Clozapine may not be feasible for many reasons, but we have documented several alternatives for managing TRP. We are continuing subgroup analyses, along with a comparator group successfully started on clozapine during admission. These results may inform clinical decision making in this difficult-to-treat population.
Download the poster here: Dr. Randall White Final 2.