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 language | English |
|---|---|
| Journal | Early Intervention in Psychiatry |
| DOIs | |
| Publication status | Accepted/In press - 2017 |
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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
Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized : A retrospective analysis of real-world practice. / Yoshimura, Bunta; Sato, Kojiro; Takaki, Manabu; Yamada, Norihito.
In: Early Intervention in Psychiatry, 2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Algorithm-based pharmacotherapy for first-episode schizophrenia involuntarily hospitalized
T2 - A retrospective analysis of real-world practice
AU - Yoshimura, Bunta
AU - Sato, Kojiro
AU - Takaki, Manabu
AU - Yamada, Norihito
PY - 2017
Y1 - 2017
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.
KW - Algorithm-based pharmacotherapy
KW - First-episode
KW - Involuntary hospitalization
KW - Schizophrenia
KW - Treatment-resistance
UR - http://www.scopus.com/inward/record.url?scp=85019396173&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019396173&partnerID=8YFLogxK
U2 - 10.1111/eip.12442
DO - 10.1111/eip.12442
M3 - Article
C2 - 28523839
AN - SCOPUS:85019396173
JO - Early Intervention in Psychiatry
JF - Early Intervention in Psychiatry
SN - 1751-7885
ER -