클로자핀의 지연된 사용이 치료저항성 조현병 환자의 급성기 약물 반응에 미치는 영향
Effect of Delayed Clozapine Initiation on Acute Treatment Response in Treatment-Resistant Schizophrenia
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: Recent studies have reported that delayed initiation of clozapine can affect clinical response in patients with treatment- resistant schizophrenia (TRS). This study aimed to explore the relationship between delayed initiation of clozapine and acute treatment response. Methods: Sixty-five inpatients with TRS who started clozapine for the first time were included through a retrospective chart review. Acute treatment response was defined as a 30% reduction in the Positive and Negative Syndrome Scale score or a Clinical Global Impression of Improvement score of 1 (very much improved) or 2 (much improved) at 4 weeks after initiating clozapine. Results: After meeting the TRS criteria, the mean delay for initiating clozapine was approximately 13.8 months. The delay was shorter in patients who showed a better response to clozapine in logistic regression analysis (p=0.037). Conclusion: Our findings suggest that reducing the delay in initiating clozapine increases the effectiveness of clozapine in patients with TRS.
Abstract
Objectives: Recent studies have reported that delayed initiation of clozapine can affect clinical response in patients with treatment- resistant schizophrenia (TRS). This study aimed to explore the relationship between delayed initiation of clozapine and acute treatment response. Methods: Sixty-five inpatients with TRS who started clozapine for the first time were included through a retrospective chart review. Acute treatment response was defined as a 30% reduction in the Positive and Negative Syndrome Scale score or a Clinical Global Impression of Improvement score of 1 (very much improved) or 2 (much improved) at 4 weeks after initiating clozapine. Results: After meeting the TRS criteria, the mean delay for initiating clozapine was approximately 13.8 months. The delay was shorter in patients who showed a better response to clozapine in logistic regression analysis (p=0.037). Conclusion: Our findings suggest that reducing the delay in initiating clozapine increases the effectiveness of clozapine in patients with TRS.
참고문헌 (44)
- Lehman AF, "Practice guideline for the treatment of patients with schizophrenia", Am J Psychiatry, 161(2 Suppl), pp.1~56 (2004)
- Lally J, "Treatment resistant schizophrenia-review and a call to action", Ir J Psychol Med, 36, pp.279~291 (2019)
- Howes OD, "Treatment-resistant schizophrenia:treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology", Am J Psychiatry, 174, pp.216~229 (2017)
- Gillespie AL, "Is treatment-resistant schizophrenia categorically distinct from treatmentresponsive schizophrenia? A systematic review", BMC Psychiatry, 17, pp.1~14 (2017)
- National Collaborating Centre for Mental Health (UK)., "Psychosis and schizophrenia in adults: treatment and management" (2014), National Institute for Health and Care Excellence (UK)
- 이건석, "치료저항성 조현병: 정의와 임상양상", 대한조현병학회지, 23(2), pp.45~50 (2020), 대한조현병학회[DOI]
- Kinon BJ, "The group of treatment resistant schizophrenias. Heterogeneity in treatment resistant schizophrenia (TRS)", Front Psychiatry, 9, pp.757~ (2019)
- Meltzer HY, "Age at onset and gender of schizophrenic patients in relation to neuroleptic resistance", Am J Psychiatry, 154, pp.475~482 (1997)
- Rebecca Schennach, "Treatment Response in First-episode Schizophrenia", Clinical Psychopharmacology and Neuroscience, 10(2), pp.78~87 (2012), 대한정신약물학회[DOI]
- Kane J, "Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine", Arch Gen Psychiatry, 45, pp.789~796 (1988)
- Kane JM, "The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary", J Clin Psychiatry, 64, pp.5~19 (2003)
- Meltzer HY, "A randomized, double-blind comparison of clozapine and highdose olanzapine in treatment-resistant patients with schizophrenia", J Clin Psychiatry, 69, pp.274~285 (2008)
- Leucht S, "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis", Lancet, 382, pp.951~962 (2013)
- Wheeler A, "Outcomes for schizophrenia patients with clozapine treatment: how good does it get?", J Psychopharmacol, 23, pp.957~965 (2009)
- Hasan A, "World Federation of Societies of Biological Psychiatry (WFSBP)Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance", World J Biol Psychiatry, 13, pp.318~378 (2012)
- Norman R, "Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults", Can J Psychiatry, 62, pp.617~623 (2017)
- Taylor DM, "Prior antipsychotic prescribing in patients currently receiving clozapine : a case note review", J Clin Psychiatry, 64, pp.30~34 (2003)
- Howes OD, "Adherence to treatment guidelines in clinical practice : study of antipsychotic treatment prior to clozapine initiation", Br J Psychiatry, 201, pp.481~485 (2012)
- 김세현, "치료저항성 조현병에서 클로자핀 치료의 현황", 대한조현병학회지, 24(1), pp.1~7 (2021), 대한조현병학회[DOI]
- Wheeler AJ, "Pathway to clozapine use : a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom", Clin Drug Investig, 34, pp.203~211 (2014)
- 강시현, "클로자핀 처방 패턴 및 클로자핀 중단과 관련된 임상 요인", 대한조현병학회지, 22(1), pp.2~7 (2019), 대한조현병학회[DOI]
- Okhuijsen-Pfeifer C, "Demographic and clinical features as predictors of clozapine response in patients with schizophrenia spectrum disorders : a systematic review and meta-analysis", Neurosci Biobehav Rev, 111, pp.246~252 (2020)
- Griffiths K, "Demographic and clinical variables associated with response to clozapine in schizophrenia : a systematic review and meta-analysis", Psychol Med, 51, pp.376~386 (2021)
- Altamura A, "Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia : a retrospective study", Schizophr Res, 52, pp.29~36 (2001)
- Perkins DO, "Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia : a critical review and meta-analysis", Am J Psychiatry, 162, pp.1785~1804 (2005)
- Shah P, "The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia : a systematic review", Psychiatry Res, 268, pp.114~122 (2018)
- Shah P, "Clozapine response trajectories and predictors of non-response in treatment-resistant schizophrenia : a chart review study", Eur Arch Psychiatry Clin Neurosci, 270, pp.11~22 (2020)
- Üçok A, "Delayed initiation of clozapine may be related to poor response in treatment-resistant schizophrenia", Int Clin Psychopharmacol, 30, pp.290~295 (2015)
- Jung Suk Lee, "Korean Medication Algorithm for Schizophrenia 2019, Second Revision: Treatment of Psychotic Symptoms", Clinical Psychopharmacology and Neuroscience, 18(3), pp.386~394 (2020), 대한정신약물학회[DOI]
- Kay SR, "The positive and negative syndrome scale(PANSS)for schizophrenia", Schizophr Bull, 13, pp.261~ (1987)
- Guy W, "ECDEU assessment manual for psychopharmacology" (1976), National Institute of Mental Health
- Leucht S, "Linking the PANSS, BPRS, and CGI: clinical implications", Neuropsychopharmacology, 31, pp.2318~2325 (2006)
- Yoshimura B, "The critical treatment window of clozapine in treatment-resistant schizophrenia : secondary analysis of an observational study", Psychiatry Res, 250, pp.65~70 (2017)
- Thien K, "Delays and barriers to the commencement of clozapine in eligible people with a psychotic disorder : a literature review", Early Interv Psychiatry, 13, pp.18~23 (2019)
- 조진우, "클로자핀 중단의 이유", 대한조현병학회지, 19(1), pp.17~24 (2016), 대한조현병학회
- Hayhurst KP, "Postcode prescribing for schizophrenia", Br J Psychiatry, 182, pp.281~283 (2003)
- Cirulli G, "Clozapine prescribing in adolescent psychiatry : survey of prescribing practice in in-patient units", Psychiatr Bull, 29, pp.377~380 (2005)
- Farooq S, "Barriers to using clozapine in treatment-resistant schizophrenia : systematic review", B J Psych Bull, 43, pp.8~16 (2019)
- Gee S, "Practitioner attitudes to clozapine initiation", Acta Psychiatr Scand, 130, pp.16~24 (2014)
- Iqbal MM, "Clozapine : a clinical review of adverse effects and management", Ann Clin Psychiatry, 15, pp.33~48 (2003)
- Laker M, "Long-term outcome with clozapine : comparison of patients continuing and discontinuing treatment", Int Clin Psychopharmacol, 13, pp.75~78 (1998)
- Young CR, "Management of the adverse effects of clozapine", Schizophr Bull, 24, pp.381~ (1998)
- 전윤희, "조현병 환자의 재원일수 결정요인 : 건강보험 입원환자데이터셋 자료를 이용하여", 디지털융복합연구, 18(1), pp.257~263 (2020), 한국디지털정책학회[DOI]
- Conley RR, "Time to clozapine response in a standardized trial", Am J Psychiatry, 154, pp.1243~1247 (1997)
