Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized

A retrospective analysis of real-world practice

Bunta Yoshimura, Kojiro Sato, Manabu Takaki, Norihito Yamada

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. Methods: We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. Results: The physician adherence rate to ABP was 95%. Response and remission rates were 76.0% and 48.6% in the first adequate antipsychotic trial (Phase I, n=146), 62.5% and 25.0% in the second adequate antipsychotic trial (Phase II, n=32), and 16.7% and 0% in the third adequate antipsychotic trial (Phase III, n=6). Response and remission rates in the clozapine trial (n=9) increased to nearly the level of Phase I (66.7% and 44.4%). The treatment-resistance rate was 8.4% to 10.3%. Conclusions: These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.

Original languageEnglish
JournalEarly Intervention in Psychiatry
DOIs
Publication statusAccepted/In press - 2017

Fingerprint

Antipsychotic Agents
Schizophrenia
Clozapine
Drug Therapy
olanzapine
Therapeutics
Clinical Trials
Physicians

Keywords

  • Algorithm-based pharmacotherapy
  • First-episode
  • Involuntary hospitalization
  • Schizophrenia
  • Treatment-resistance

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

@article{7460a779d082486ebbfdba419b954bb2,
title = "Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized: A retrospective analysis of real-world practice",
abstract = "Background: Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. Methods: We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. Results: The physician adherence rate to ABP was 95{\%}. Response and remission rates were 76.0{\%} and 48.6{\%} in the first adequate antipsychotic trial (Phase I, n=146), 62.5{\%} and 25.0{\%} in the second adequate antipsychotic trial (Phase II, n=32), and 16.7{\%} and 0{\%} in the third adequate antipsychotic trial (Phase III, n=6). Response and remission rates in the clozapine trial (n=9) increased to nearly the level of Phase I (66.7{\%} and 44.4{\%}). The treatment-resistance rate was 8.4{\%} to 10.3{\%}. Conclusions: These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.",
keywords = "Algorithm-based pharmacotherapy, First-episode, Involuntary hospitalization, Schizophrenia, Treatment-resistance",
author = "Bunta Yoshimura and Kojiro Sato and Manabu Takaki and Norihito Yamada",
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doi = "10.1111/eip.12442",
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journal = "Early Intervention in Psychiatry",
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AU - Takaki, Manabu

AU - Yamada, Norihito

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N2 - Background: Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. Methods: We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. Results: The physician adherence rate to ABP was 95%. Response and remission rates were 76.0% and 48.6% in the first adequate antipsychotic trial (Phase I, n=146), 62.5% and 25.0% in the second adequate antipsychotic trial (Phase II, n=32), and 16.7% and 0% in the third adequate antipsychotic trial (Phase III, n=6). Response and remission rates in the clozapine trial (n=9) increased to nearly the level of Phase I (66.7% and 44.4%). The treatment-resistance rate was 8.4% to 10.3%. Conclusions: These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.

AB - Background: Little is known about the clinical outcomes of severely ill patients with first-episode schizophrenia spectrum disorders (FES) who are considered to lack the capacity to consent to clinical trials. We investigated the feasibility of an algorithm-based pharmacotherapy (ABP) and clinical outcomes of patients with FES involuntarily hospitalized and treated with ABP. Methods: We conducted a retrospective chart review of 160 patients admitted involuntarily between October 2012 and October 2015. Our algorithm aimed to delay olanzapine, standardize medications and suggest initiation of clozapine after failure (non-response or intolerability) of third-line antipsychotic treatment. The duration of each adequate antipsychotic treatment at optimal dosage was 4 weeks or more. Results: The physician adherence rate to ABP was 95%. Response and remission rates were 76.0% and 48.6% in the first adequate antipsychotic trial (Phase I, n=146), 62.5% and 25.0% in the second adequate antipsychotic trial (Phase II, n=32), and 16.7% and 0% in the third adequate antipsychotic trial (Phase III, n=6). Response and remission rates in the clozapine trial (n=9) increased to nearly the level of Phase I (66.7% and 44.4%). The treatment-resistance rate was 8.4% to 10.3%. Conclusions: These findings suggested the validity of ABP and initiation of clozapine for treatment-resistant psychotic symptoms for even severely ill involuntarily hospitalized patients with FES.

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