The impact of clozapine initiation and cessation on psychiatric hospital admissions and bed days: a mirror image cohort study.
Adult
Antipsychotic Agents
/ therapeutic use
Australia
/ epidemiology
Clozapine
/ therapeutic use
Cohort Studies
Female
Hospitals, Psychiatric
/ trends
Humans
Length of Stay
/ trends
Male
Middle Aged
Patient Admission
/ trends
Retrospective Studies
Schizophrenia
/ diagnosis
Withholding Treatment
/ trends
Admission
Cessation
Clozapine
Hospitalisation
Mirror image
Schizophrenia
Journal
Psychopharmacology
ISSN: 1432-2072
Titre abrégé: Psychopharmacology (Berl)
Pays: Germany
ID NLM: 7608025
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
24
10
2018
accepted:
23
01
2019
pubmed:
5
2
2019
medline:
29
10
2019
entrez:
5
2
2019
Statut:
ppublish
Résumé
Clozapine is the most effective medication for the positive symptoms of treatment-refractory schizophrenia. Although clozapine use is associated with fewer admissions, less is known about the impact of clozapine cessation on hospitalisation. The aims of this study were to investigate whether clozapine-reduced psychiatric inpatient admissions and bed days, and investigate patient factors associated with these changes from a sample of 1906 people commenced on clozapine. All people commencing clozapine during an acute hospitalisation over a 10-year period in Queensland, Australia, were included in this retrospective cohort study. A mirror image design was used to compare psychiatric bed days and hospitalisations 2 years before and after clozapine treatment, and the impact of clozapine continuation or early cessation. Changes in psychiatric bed days and hospitalisations were analysed using linear regression, adjusting for the duration on clozapine, sex, age, indigenous status, country of origin and time to clozapine commencement. There was a significant reduction in bed days (29.55 days vs 24.46 days, p < 0.001) and admissions (2.27 vs 1.87 < 0.001) associated with clozapine commencement. This remained significant among clozapine continuers, but not among those with early cessation. Longer duration on clozapine was associated with greater reductions in psychiatric bed days and admissions. Age, sex and time to clozapine commencement, indigeneity and country of origin did not impact outcomes. Longer clozapine therapy led to a greater reduction in psychiatric bed days and hospitalisations. Early cessation was associated with a return to pre-clozapine levels of bed days and admissions.
Sections du résumé
BACKGROUND
BACKGROUND
Clozapine is the most effective medication for the positive symptoms of treatment-refractory schizophrenia. Although clozapine use is associated with fewer admissions, less is known about the impact of clozapine cessation on hospitalisation.
AIMS
OBJECTIVE
The aims of this study were to investigate whether clozapine-reduced psychiatric inpatient admissions and bed days, and investigate patient factors associated with these changes from a sample of 1906 people commenced on clozapine.
METHODS
METHODS
All people commencing clozapine during an acute hospitalisation over a 10-year period in Queensland, Australia, were included in this retrospective cohort study. A mirror image design was used to compare psychiatric bed days and hospitalisations 2 years before and after clozapine treatment, and the impact of clozapine continuation or early cessation. Changes in psychiatric bed days and hospitalisations were analysed using linear regression, adjusting for the duration on clozapine, sex, age, indigenous status, country of origin and time to clozapine commencement.
RESULTS/OUTCOMES
RESULTS
There was a significant reduction in bed days (29.55 days vs 24.46 days, p < 0.001) and admissions (2.27 vs 1.87 < 0.001) associated with clozapine commencement. This remained significant among clozapine continuers, but not among those with early cessation. Longer duration on clozapine was associated with greater reductions in psychiatric bed days and admissions. Age, sex and time to clozapine commencement, indigeneity and country of origin did not impact outcomes.
CONCLUSION/INTERPRETATION
CONCLUSIONS
Longer clozapine therapy led to a greater reduction in psychiatric bed days and hospitalisations. Early cessation was associated with a return to pre-clozapine levels of bed days and admissions.
Identifiants
pubmed: 30715572
doi: 10.1007/s00213-019-5179-6
pii: 10.1007/s00213-019-5179-6
doi:
Substances chimiques
Antipsychotic Agents
0
Clozapine
J60AR2IKIC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1931-1935Subventions
Organisme : Medical Research Council
ID : MR/L011794/1
Pays : United Kingdom
Organisme : National Health and Medical Research Council
ID : APP1111136
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