Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T09:39:30.407Z Has data issue: false hasContentIssue false
  • English
  • Français

A survey of clozapine prescribing for inpatients in a tertiary psychiatric hospital

Published online by Cambridge University Press:  13 June 2014

Camilla Haw ,
Jean Stubbs  and
Christopher Mountjoy
Jean Stubbs
Affiliation:
St Andrew's Hospital
Christopher Mountjoy
Affiliation:
Billing Road, Northampton NN1 5DG, England
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To audit the prescribing of clozapine for inpatients at a large, specialist psychiatric hospital.

Method: The clinical standards used were agreed by the authors after reference to the clozapine data sheet and British National Formulary (BNF). Prescribing practices for forty-six patients were audited.

Results: In this population of difficult to manage, treatment-resistant schizophrenic patients, prescribing and case note documentation needed improvement. Although almost all of these patients had had an adequate trial of clozapine monotherapy, over a quarter were currently receiving clozapine augmented with another antipsychotic. Plasma clozapine monitoring was used only once in a patient who had failed to respond adequately to clozapine.

Conclusions: Clinicians should fully document the patient's consent to treatment, the clinical response to treatment and the reasons for any deviation in clinical practice from that recommended by the data sheet and national formulary. Plasma clozapine monitoring should be used to optimise therapy and clinical rating scales should be used to evaluate outcome. Until the clinical effectiveness of clozapine augmentation strategies is proven, their use should be restricted to cases where evidence-based therapies have failed.

Keywords

ClozapineSchizophreniaAugmentationAudit.
Type
Audit
Information
Irish Journal of Psychological Medicine , Volume 17 , Issue 3 , September 2000 , pp. 91 - 95
Copyright
Copyright © Cambridge University Press 2000

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

1.Kane, J, Honigfeld, G, Singer, J, Meltzer, H and the Clozaril Collaborative Study Group. Clozapine tor the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–96.CrossRefGoogle Scholar
2.Novartis Pharmaceuticals UK. Clozaril Patient Monitoring Service Update. Clozaril Patient Monitoring Service Newsletter 1999; 22: 3.Google Scholar
3. British Medical Association and the Royal Pharmaceutical Society of Great Britain. British National Formulary Number 37 British Medical Association and the Roval Pharmaceutical Society, London, 1999.Google Scholar
4. Mental Health Act 1983. HMSO, London.Google Scholar
5.Overall, JE, Gorham, DR. The Brief Psychiatric Rating Scale. Psychol Rep 1962;10:799–812.CrossRefGoogle Scholar
6.Rabinowitz, J, Avnon, M, Rosenberg, V. Effect of clozapine on physical and verbal aggression. Schizophrenia Research 1996; 22(3): 249–55.CrossRefGoogle ScholarPubMed
7.De Domenico, P, Di Rosa, AE, D'Agostino, AA, Martino, G, Meduri, M, Spina, E. The effect of clozapine on aggressive behaviour in patients with chronic schizophrenia. Int J of Psych in Clin Practice 1999; 3(1): 49–54.CrossRefGoogle ScholarPubMed
8.The Special Hospitals Treatment Resistant Schizophrenia Research Group. Br J Psychiat 1996; 169 (Suppl. 31): 21–30.CrossRefGoogle Scholar
9.Clozapine Study Group. The safety and efficacy of clozapine in severe treatment-resistant schizophrenic patients in the UK. Br J Psychiatry 1993; 163: 150–4.CrossRefGoogle Scholar
10.Miller, DD. The clinical use of clozapine plasma concentrations in the management of treatment-refractory schizophrenia. Ann Clin Psychiatry 1996; 8(2):99–109.CrossRefGoogle ScholarPubMed
11.Bell, R, McLaren, A, Galanos, J, Copolov, D. The clinical use of plasma clozapine levels. Australian and New Zealand J Psychiatry 1998; 32(4): 567–74.CrossRefGoogle ScholarPubMed
12.Stubbs, J, Haw, C, Staley, C, Mountjoy, C (in press). Augmentation with sulpiride for a schizophrenic patient partially responsive to clozapine. Acta Psychiatrica Scand.Google Scholar
13.Peacock, L, Gerlach, J. Clozapine treatment in Denmark: concomitant psychotropic medication and hematologic monitoring in a system with liberal usage practices. J Clin Psychiatry 1994; 55(2): 44–9.Google Scholar
14.Leppig, M. Bosch, B, Naber, D, Hippius, H. Clozapine in the treatment of 121 outpatients. Psychopharm 1989; 99: S77–S79.CrossRefGoogle ScholarPubMed
15.Shiloh, R, Zemishlany, Z, Aizenberg, Det al.Sulpiride augmentation in people with schizophrenia partially responsive to clozapine: A double-blind, placebo-controlled study. Br J Psychiatry 1997; 171: 569–573.CrossRefGoogle ScholarPubMed
16.Miller, CH, Mohr, F, Umbricht, D, Woerner, M, Fleischhacker, WW, Lieberman, JA. The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone, and conventional antipsychotics. J Clin Psychiatry 1998; 59(2): 69–75.CrossRefGoogle ScholarPubMed
17.Taylor, D, McConnell, D, Abel, K, Kerwin, R. The Bethlem & Maudsley NHS Trust Prescribing Guidelines. 5th Edition. London, Martin Dunitz: 159, 1999.Google Scholar