Skip to main content
×
×
Home

Clozapine users in Australia: their characteristics and experiences of care based on data from the 2010 National Survey of High Impact Psychosis

  • D. J. Siskind (a1) (a2) (a3), M. Harris (a3) (a4), A. Phillipou (a5) (a6), V. A. Morgan (a7), A. Waterreus (a7), C. Galletly (a8), V. J. Carr (a9) (a10), C. Harvey (a6) (a11) and D. Castle (a5) (a6)...
Abstract
Aims.

Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.

Methods.

Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n = 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.

Results.

One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.

Conclusions.

Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.

Copyright
Corresponding author
*Address for correspondence: D. J. Siskind, MIRT, 519 Kessels Rd, MacGregor, Qld, Australia. (Email: d.siskind@uq.edu.au)
References
Hide All
Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, Remington G (2011). An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. Journal of Clinical Psychiatry 72, 14391444.
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart J-C, James WPT, Loria CM, Smith SC, International Association for the Study of Obesity (2009). Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.
Blair JR, Spreen O (1989). Predicting premorbid IQ: a revision of the National Adult Reading Test. Clinical Neuropsychologist 3, 129136.
Castle D, Morgan V, Jablensky A (2002). Antipsychotic use in Australia: the patients’ perspective. Australian and New Zealand Journal of Psychiatry 36, 633641.
Castle DJ, Jablensky A, McGrath JJ, Carr V, Morgan V, Waterreus A, Valuri G, Stain H, McGuffin P, Farmer A (2006). The diagnostic interview for psychoses (DIP): development, reliability and applications. Psychological Medicine 36, 6980.
Chong SA, Remington GJ, Bezchlibnyk-Butler KZ (2000). Effect of clozapine on polypharmacy. Psychiatric Services (Washington, D.C.) 51, 250252.
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise 35, 13811395.
Crawford JR, Deary IJ, Starr J, Whalley LJ (2001). The NART as an index of prior intellectual functioning: a retrospective validity study covering a 66-year interval. Psychological Medicine 31, 451458.
Drake RE, Xie H, McHugo GJ, Green AI (2000). The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophrenia Bulletin 26, 441449.
Forrester T, Siskind D, Winckel K, Wheeler A, Hollingworth S (2015). Increasing clozapine dispensing trends in Queensland, Australia 2004–2013. Pharmacopsychiatry 48, 164169.
Gallego JA, Nielsen J, De Hert M, Kane JM, Correll CU (2012). Safety and tolerability of antipsychotic polypharmacy. Expert Opinion on Drug Safety 11, 527542.
Galletly CA, Foley DL, Waterreus A, Watts GF, Castle DJ, McGrath JJ, Mackinnon A, Morgan VA (2012). Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 753761.
Gee S, Vergunst F, Howes O, Taylor D (2014). Practitioner attitudes to clozapine initiation. Acta Psychiatrica Scandinavica 130, 1624.
Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, Jeste DV (2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry 161, 692699.
Green AI, Zimmet SV, Strous RD, Schildkraut JJ (1999). Clozapine for comorbid substance use disorder and schizophrenia: do patients with schizophrenia have a reward-deficiency syndrome that can be ameliorated by clozapine? Harvard review of Psychiatry 6, 287296.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO (1991). The Fagerström test for nicotine dependence: a revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction 86, 11191127.
Henderson DC, Nguyen DD, Copeland PM, Hayden DL, Borba CP, Louie PM, Freudenreich O, Evins AE, Cather C, Goff DC (2005). Clozapine, diabetes mellitus, hyperlipidemia, and cardiovascular risks and mortality: results of a 10-year naturalistic study. Journal of Clinical Psychiatry 66, 11161121.
Howes OD, Vergunst F, Gee S, McGuire P, Kapur S, Taylor D (2012). Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. British Journal of Psychiatry: the Journal of Mental Science 201, 481485.
Jablensky A, McGrath J, Herrman H, Castle D, Gureje O, Evans M, Carr V, Morgan V, Korten A, Harvey C (2000). Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Australian and New Zealand Journal of Psychiatry 34, 221236.
Kane J, Honigfeld G, Singer J, Meltzer H (1988). Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Archives of General Psychiatry 45, 789796.
Kirkpatrick B, Buchanan RW, McKenney PD, Alphs LD, Carpenter WT (1989). The schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Research 30, 119123.
Leucht S, Cipriani A, Spineli L, Mavridis D, Örey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet 382, 951962.
McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK (2006). Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. American Journal of Psychiatry 163, 600610.
Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M, Chouinard G, Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S, International Suicide Prevention Trial Study Group (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Archives of General Psychiatry 60, 8291.
Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M (2013). Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders–a systematic review and meta-analysis. Schizophrenia Bulletin 39, 306318.
Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, Bush R, Castle D, Cohen M, Harvey C, Galletly C, Stain HJ, Neil AL, McGorry P, Hocking B, Shah S, Saw S (2012). People living with psychotic illness in 2010: the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 735752.
Morgan VA, McGrath JJ, Jablensky A, Badcock JC, Waterreus A, Bush R, Carr V, Castle D, Cohen M, Galletly C, Harvey C, Hocking B, McGorry P, Neil AL, Saw S, Shah S, Stain HJ, Mackinnon A (2013). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine, 114.
Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323329.
Nasrallah H, Morosini P, Gagnon DD (2008). Reliability, validity and ability to detect change of the Personal and Social Performance scale in patients with stable schizophrenia. Psychiatry Research 161, 213224.
Nielsen J, Damkier P, Lublin H, Taylor D (2011). Optimizing clozapine treatment. Acta Psychiatrica Scandinavica 123, 411422.
Nielsen J, Røge R, Schjerning O, Sørensen HJ, Taylor D (2012). Geographical and temporal variations in clozapine prescription for schizophrenia. European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology 22, 818824.
Patrick DL, Burns T, Morosini P, Rothman M, Gagnon DD, Wild D, Adriaenssen I (2009). Reliability, validity and ability to detect change of the clinician-rated Personal and Social Performance scale in patients with acute symptoms of schizophrenia. Current Medical Research and Opinion 25, 325338.
Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R (2002). Effects of psychotropic drugs on seizure threshold. Drug Safety 25, 91110.
Randolph C (1998). RBANS Manual: Repeatable Battery for the Assessment of Neuropsychological Status. The Psychological Corporation: San Antonio, TX.
Schretlen DJ, Buffington ALH, Meyer SM, Pearlson GD (2005). The use of word-reading to estimate ‘premorbid’ ability in cognitive domains other than intelligence. Journal of the International Neuropsychological Society: JINS 11, 784787.
Seidel S, Aigner M, Ossege M, Pernicka E, Wildner B, Sycha T (2013). Antipsychotics for acute and chronic pain in adults. Cochrane Database of Systematic Reviews (Online) 8, CD004844.
Sernyak MJ, Rosenheck RA (2008). Antipsychotic use in the treatment of outpatients with schizophrenia in the VA from fiscal years 1999 to 2006. Psychiatric Services (Washington, DC) 59, 567569.
Siskind D, McCartney L, Goldschlager R, Kisely S (2016). Clozapine versus first and second-generation antipsychotics in treatment refractory schizophrenia: systematic review & meta-analysis. British Journal of Psychiatry, in press.
Tang Y-L, Mao P-X, Jiang F, Chen Q, Wang C-Y, Cai Z-J, Mitchell PB (2008). Clozapine in China. Pharmacopsychiatry 41, 19.
Taylor DM, Young C, Paton C (2003). Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review. Journal of Clinical Psychiatry 64, 3034.
Taylor DM, Smith L, Gee SH, Nielsen J (2012). Augmentation of clozapine with a second antipsychotic – a meta-analysis. Acta Psychiatrica Scandinavica 125, 1524.
Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, Haukka J (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620627.
Varma S, Bishara D, Besag FMC, Taylor D (2011). Clozapine-related EEG changes and seizures: dose and plasma-level relationships. Therapeutic Advances in Psychopharmacology 1, 4766.
Waterreus A, Morgan VA, Castle D, Galletly C, Jablensky A, Di Prinzio P, Shah S (2012). Medication for psychosis–consumption and consequences: the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 762773.
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N (1990). SCAN: schedules fonr clinical assessment in neuropsychiatry. Archives of General Psychiatry 47, 589593.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 12
Total number of PDF views: 111 *
Loading metrics...

Abstract views

Total abstract views: 466 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th February 2018. This data will be updated every 24 hours.