TITLE

Evaluating the use of enforced clozapine in an Australian forensic psychiatric setting: two cases

AUTHOR(S)
Kasinathan, John; Mastroianni, Tony
PUB. DATE
January 2007
SOURCE
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background To evaluate the administration, outcomes and ethical issues of enforced clozapine in two patients with treatment-resistant schizophrenia/schizoaffective disorder in a forensic psychiatric setting, who were refusing oral clozapine. Methods "Enforced clozapine" implied that if a patient refused oral clozapine they received intramuscular clozapine at half the expected oral dose. The case series involved 12 months follow-up. Baseline and monthly measures included the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Global Assessment of Functioning (GAF), Insight and Treatment Attitudes Questionnaire (ITAQ) and Quality of Life Self-Assessment Inventory (QLS-100). Routine haematological, metabolic and cardiac monitoring was informed by established clinical guidelines. Statistical analysis utilized t-Tests and Pearson's correlation coefficient. Results Enforced clozapine was reasonably well tolerated with rapid acceptance of oral clozapine. By 12 months, statistically significant improvements were seen in BPRS (p = 0.05), CGI (p = 0.04) and GAF (p = 0.03). Improvements in ITAQ and QLS-100 were not statistically significant. BPRS and CGI were strongly negatively correlated with the length of time on enforced clozapine, clozapine dose and clozapine serum levels. GAF, QLS-100 and to a lesser extent ITAQ were positively correlated with those factors. Conclusion Enforced clozapine is a viable short-term treatment option in treatment-resistant patients who are refusing oral clozapine. It resulted in significantly reduced psychotic symptoms, reduced dangerousness, a better quality of life, improved insight into their illness and long-term acceptance of oral clozapine. Unfortunately recent global non-production of parenteral clozapine means that this promising intervention in selected treatment-resistant patients cannot be further evaluated and judiciously implemented.
ACCESSION #
35704246

 

Related Articles

  • Phospholipase C-β1 knockout mice exhibit endophenotypes modeling schizophrenia which are rescued by environmental enrichment and clozapine administration. McOmish, C. E.; Burrows, E.; Howard, M.; Scarr, E.; Kim, D.; Shin, H.-S.; Dean, B.; van den Buuse, M.; Hannan, A. J. // Molecular Psychiatry;Jul2008, Vol. 13 Issue 7, p661 

    Phospholipase C-β1 (PLC-β1) is a rate-limiting enzyme implicated in postnatal-cortical development and neuronal plasticity. PLC-β1 transduces intracellular signals from specific muscarinic, glutamate and serotonin receptors, all of which have been implicated in the pathogenesis of...

  • How drug savvy are you?  // Consumer Reports on Health;Jan1999, Vol. 11 Issue 1, p1 

    Responds to various queries related to the risks and benefits of common medications. Includes reasons why `shotgun' cold remedies, which contain a combination of ingredients, are not advisable; `Rebound' congestion due to use of nasal-decongestant drops or sprays for more than three days;...

  • In plain English, please! Toscano, Maria R. // Self;May2000, Vol. 22 Issue 5, p92 

    Presents a translation of drug-label directions.

  • In vivo immunomodulatory effects of clozapine in schizophrenia. Hornig, Mady; Maes, M.; Bosmans, E.; Kenis, G.; De Jong, R.; Smith, R.S.; Meltzer, H.Y. // Advances in Mind-Body Medicine;Winter2000, Vol. 16 Issue 1, p52 

    Presents an abstract of the article 'In Vivo Immunomodulatory Effects of Clozapine in Schizophrenia,' by M. Maes, E. Bosmans, G. Kenis, R. De Jong, R.S. Smith and H.Y. Meltzer published in the 1997 issue of 'Schizophrenic Research'.

  • Clozapine.  // Reactions Weekly;9/11/2010, Issue 1318, p17 

    The article describes the case of a 32-year-old man who developed persistent paroxysmal perceptual alterations while undergoing clozapine treatment for schizophrenia.

  • Prädeliktische Behandlungswege schizophrener Patienten der forensischen Psychiatrie. Piontek, K.; Kutscher, S.-U.; König, A.; Leygraf, N. // Der Nervenarzt;Jan2013, Vol. 84 Issue 1, p55 

    Background: The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Prior to admission to a forensic ward, two thirds of schizophrenic patients have been admitted to a general...

  • Dextran sulfate is poorly absorbed after oral administration. Lorentsen, Kevin J.; Hendrix, Craig W.; Collins, Jerry M.; Kornhauser, David M.; Petty, Brent G.; Klecker, Raymond W.; Flexner, Charles; Eckel, Robert H.; Lietman, Paul S.; Lorentsen, K J; Hendrix, C W; Collins, J M; Kornhauser, D M; Petty, B G; Klecker, R W; Flexner, C; Eckel, R H; Lietman, P S // Annals of Internal Medicine;10/1/89, Vol. 111 Issue 7, p561 

    Study Objective: To determine whether dextran sulfate (molecular weight, 7000 to 8000 daltons; 17% to 20% sulfur), a synthetic heparin analogue with anti-human immunodeficiency virus (HIV) activity in vitro, is absorbed after oral administration.Design: Open-label,...

  • Antipsychotic Drugs for First-Episode Schizophrenia. Salimi, Kayvon; Jarskog, L. Fredrik; Lieberman, Jeffrey A. // CNS Drugs;2009, Vol. 23 Issue 10, p837 

    Increasingly, it is recognized that first-episode schizophrenia represents a critical stage of illness during which the effectiveness of therapeutic interventions can affect long-term outcome. In this regard, the advent of clozapine and subsequent atypical antipsychotic drugs held promise for...

  • Schizophrenia: The drug deadlock. Abbott, Alison // Nature;11/11/2010, Vol. 468 Issue 7321, p158 

    The article focuses on the clinical trials which compare the drugs for the treatment of schizophrenia. It says that the 43 million US dollars trial for testing an anti-psychotic drug introduced in 1990 revealed similar, such as perphenazine that leaves patients confused, socially withdrawn, and...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics