Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T09:24:08.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Physical health trajectories of young people commenced on clozapine

Published online by Cambridge University Press:  20 February 2020

B. O’Donoghue ,
A. Mujanovic ,
S. Young ,
T. Bridson ,
L. Mora ,
M. Bismark ,
J. Cocks ,
D. Siskind  and
P. McGorry
B. O’Donoghue*
Affiliation:
Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia Orygen Youth Health, Melbourne, Victoria, Australia
A. Mujanovic
Affiliation:
School of Medicine, Orebro University, Orebro, Sweden
S. Young
Affiliation:
Department of Psychiatry, University of Manchester, Manchester, UK
T. Bridson
Affiliation:
Cairns Hospital, Cairns, Queensland, Australia
L. Mora
Affiliation:
Orygen Youth Health, Melbourne, Victoria, Australia
M. Bismark
Affiliation:
Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
J. Cocks
Affiliation:
Orygen Youth Health, Melbourne, Victoria, Australia
D. Siskind
Affiliation:
School of Medicine, University of Queensland, Brisbane, Queensland, Australia Metro South Mental Health Services, Brisbane, Queensland, Australia
P. McGorry
Affiliation:
Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
*
*Address for correspondence: B. O’Donoghue, Orygen, National Centre of Excellence in Youth Mental Health, 35 Poplar rd, Parkville, Melbourne, Victoria, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Clozapine is the most effective antipsychotic medication, but it has the highest propensity for metabolic side effects. A clozapine clinic was established within an early intervention for psychosis service to facilitate the timely commencement of clozapine and to manage the associated adverse effects. This study describes the changes in the weight, body mass index (BMI), waist circumference and blood pressure after 6 months in young people commenced on clozapine.

Method:

This was a prospective cohort study of all young people, aged 15–24 years, commenced on clozapine within an early intervention service in Melbourne, Australia, between 01.04.2016 and 30.06.2018. Continuous data were analyzed with paired t-test and categorical with Wilcoxon signed-rank test.

Results:

Twenty-six young people received 6 months of treatment with clozapine, of whom the mean age was 19.8 years (s.d. ±3.1) and 66.7% were male. After 6 months, the mean weight gain was 5.1 kg (s.d. ±10.1 kg) and over half (53.8%) gained clinically significant weight. The proportion of young people classified as either overweight or obese rose from 69.2% to 88.5% (p = 0.006). The proportion of young people with a waist circumference above the recommended parameters increased from 57.9% to 78.9% (p = 0.008). Hypertension was present in 30%, and after 6 months, 45% had hypertension (p = 0.64). Metformin was prescribed to 34.6%, typically to those with the greatest and most rapid weight gain.

Conclusion:

Among young people with treatment resistant psychosis, clozapine is associated with significant metabolic side effects in the early stages of commencement. More interventions aimed at attenuating this weight gain are needed.

Keywords

Schizophreniapsychosisclozapinemetabolic syndromeobesity
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 38 , Issue 1: Themed Issue: Physical Health in Mental Illness , March 2021 , pp. 49 - 55
Copyright
© College of Psychiatrists of Ireland 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cho, J, Hayes, RD, Jewell, A, Kadra, G, Shetty, H, MacCabe, JH, Downs, J (2019). Clozapine and all-cause mortality in treatment-resistant schizophrenia: a historical cohort study. Acta Psychiatrica Scandinavica 139, 237–247.Google ScholarPubMed
Connolly, A, Taylor, D (2014). Factors associated with non evidence-based prescribing of antipsychotics. Therapeutic Advances in Psychopharmacology 4, 247–256.CrossRefGoogle ScholarPubMed
Curtis, J, Watkins, A, Rosenbaum, S, Teasdale, S, Kalucy, M, Samaras, K, Ward, PB (2015). Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Intervention in Psychiatry 10, 267–276.CrossRefGoogle ScholarPubMed
Demjaha, A, Lappin, JM, Stahl, D, Patel, MX, MacCabe, JH, Howes, OD, Heslin, M, Reininghaus, UA, Donoghue, K, Lomas, B, Charalambides, M, Onyejiaka, A, Fearon, P, Jones, P, Doody, G, Morgan, C, Dazzan, P, Murray, RM (2017). Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychological Medicine 47, 1981–1989.CrossRefGoogle ScholarPubMed
Eaton, S, Harrap, B, Downey, L, Thien, K, Bowtell, M, Bardell-Williams, M, Ratheesh, A, McGorry, P, O’Donoghue, B (2019). Incidence of treated first episode psychosis from an Australian early intervention service and its association with neighbourhood characteristics. Schizophrenia Research 209, 206–211.CrossRefGoogle ScholarPubMed
Hayes, RD, Downs, J, Chang, CK, Jackson, RG, Shetty, H., Broadbent, M., Hotopf, M, Stewart, R. (2015). The effect of clozapine on premature mortality: an assessment of clinical monitoring and other potential confounders. Schizophrenia Bulletin 41, 644–655.CrossRefGoogle ScholarPubMed
Health Service Executive (2019). Early intervention for psychosis model of care (https://www.hse.ie/eng/about/who/cspd/ncps/mental-health/psychosis/resources). Accessed June 2019.Google Scholar
International Diabetes Federation (2006). The IDF consenus worldwide definition of the metabolic syndrome (https://www.idf.org/e-library/). Accessed June 2019.Google Scholar
Kahn, RS, Winter Van Rossum, I, Leucht, S, McGuire, P, Lewis, SW, Leboyer, M, Arango, C, Dazzan, P, Drake, R, Heres, S, Diaz-Caneja, CM, Rujescu, D, Weiser, M, Galderisi, S, Glenthoj, B, Eijkemans, MJC, Fleischhacker, WW, Kapur, S, Sommer, IE (2018). Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching study. Lancet Psychiatry 5, 797–807.CrossRefGoogle ScholarPubMed
Lappin, JM, Wijaya, M, Watkins, A, Morell, R, Teasdale, S, Lederman, O, Rosenbaum, S, Dick, S, Ward, P, Curtis, J (2018). Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients. Schizophrenia Research 199, 367–373.CrossRefGoogle Scholar
Larsen, JR, Svensson, CK, Vedtofte, L., Jakobsen, ML, Jespersen, HS, Jakobsen, MI, Koyuncu, K, Schjerning, O, Nielsen, J, Ekstrom, CT, Holst, JJ, Correll, CU, Vilsboll, T, Fink-Jensen, A (2018). High prevalence of prediabetes and metabolic abnormalities in overweight or obese schizophrenia patients treated with clozapine or olanzapine. CNS Spectrums, 1–12. Published online ahead of print. doi:10.1017/S1092852918001311.Google ScholarPubMed
Leucht, S, Cipriani, A, Spineli, L, Mavridis, D, Orey, D, Richter, F, Samara, M, Barbui, C, Engel, RR, Geddes, JR, Kissling, W, Stapf, MP, Lassig, B, Salanti, G, Davis, JM (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382, 951–962.CrossRefGoogle ScholarPubMed
Nielsen, J, Dahm, M, Lublin, H, Taylor, D (2010). Psychiatrists’ attitude towards and knowledge of clozapine treatment. Journal of Psychopharmacology 24, 965–971.CrossRefGoogle ScholarPubMed
Paranthaman, R, Baldwin, RC (2006). Survey of clozapine use by consultant old age psychiatrists. Psychiatric Bulletin 30, 410–412.CrossRefGoogle Scholar
Siskind, D, Friend, N, Russell, A, McGrath, JJ, Lim, C, Patterson, S, Flaws, D, Stedman, T, Moudgil, V, Sardinha, S, Suetani, S, Kisely, S, Winckel, K, Baker, A (2018). CoMET: a protocol for a randomised controlled trial of co-commencement of METformin as an adjunctive treatment to attenuate weight gain and metabolic syndrome in patients with schizophrenia newly commenced on clozapine. BMJ Open 8, e021000. doi: 10.1136/bmjopen-2017-021000.CrossRefGoogle ScholarPubMed
Siskind, D, McCartney, L, Goldschlager, R, Kisely, S (2016a). Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis. British Journal of Psychiatry 209, 385–392.CrossRefGoogle ScholarPubMed
Siskind, D, Reddel, T, MacCabe, JH, Kisely, S (2019). The impact of clozapine initiation and cessation on psychiatric hospital admissions and bed days: a mirror image cohort study. Psychopharmacology (Berl) 236, 1931–1935.CrossRefGoogle ScholarPubMed
Siskind, DJ, Leung, J, Russell, AW, Wysoczanski, D, Kisely, S (2016b). Metformin for clozapine associated obesity: a systematic review and meta-analysis. PLoS One, 11, e0156208.CrossRefGoogle ScholarPubMed
Thien, K, Bowtell, M, Eaton, S, Bardell-Williams, M, Downey, L, Ratheesh, A, McGorry, P, O’Donoghue, B (2018). Clozapine use in early psychosis. Schizophrenia Research 199, 374–379.CrossRefGoogle ScholarPubMed
Thien, K, O’Donoghue, B (2018). Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder: a literature review. Early Intervention in Psychiatry, 13, 18–23.CrossRefGoogle ScholarPubMed
Tiihonen, J, Lonnqvist, 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, 620–627.CrossRefGoogle Scholar
Wimberley, T, MacCabe, JH, Laursen, TM, Sorensen, HJ, Astrup, A, Horsdal, HT, Gasse, C, Stovring, H (2017). Mortality and self-harm in association with clozapine in treatment-resistant schizophrenia. American Journal of Psychiatry 174, 990–998.CrossRefGoogle Scholar