Friday, August 16, 2019

Military Personnel With Suicidal Ideation Less Likely to Store Firearms Safely at Home

Military personnel who have firearms at home and a history of thoughts of death or self-harm are less likely to store their firearms in a safe manner than those with no such history, a study in JAMA Network Open has found.

Craig J. Bryan, Psy.D., of the National Center for Veterans Studies at the University of Utah and colleagues examined the firearm storage practices of 1,652 active-duty military personnel who were seen in military primary care clinics between July 2015 and August 2018. They used the Behavioral Risk Factor Surveillance System to ask participants about firearm ownership and defined safe storage as keeping firearms locked up and unloaded. They used the Self-injurious Thoughts and Behaviors Interview to assess participants’ lifetime history of suicidal ideation and attempts and item 9 of the Patient Health Questionnaire-9 to assess whether the participants had thoughts of death or self-harm in the preceding two weeks. 

Of 1,652 study participants, 590 (36%) reported a firearm in or around their home. The researchers found that participants who had recent thoughts of death or self-harm were 39% less likely to have a firearm in the home than participants who did not have such thoughts. However, among all participants who reported keeping firearms in the home, those with a lifetime history of suicidal ideation were 53% less likely to store their firearms safely than those with no such history, and those with recent thoughts of death or self-harm were 74% less likely to store their firearms safely. 

“This highlights the importance of emphasizing safe storage of personally owned firearms, including temporary removal of access to firearms for high-risk personnel,” the researchers wrote. “Further research focused on firearm availability and storage practices among military personnel is warranted.”

For related news, see the Psychiatric News article “How to Reduce Risk of Suicide by Firearms.”

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Thursday, August 15, 2019

LAIs May Lower Rehospitalization Risk in Older Patients With Schizophrenia

Older people with schizophrenia who are treated with long-acting injectable antipsychotics (LAIs) are less likely to be rehospitalized than their peers who are treated with oral antipsychotics, suggests a study in the American Journal of Geriatric Psychiatry.

Ching-Hua Lin, M.D., Ph.D., of the Kaohsiung Municipal Kai-Syuan Psychiatric Hospital in Taiwan and colleagues followed 1,168 patients aged 60 years or older who were discharged from the public psychiatric hospital between 2006 and 2017. The patients had either schizophrenia or schizoaffective disorder, 151 were discharged on LAIs, and 1,017 were discharged on oral antipsychotics. The researchers reviewed rehospitalizations that occurred within a year of discharge for both groups of patients, including those who had exhibited significant psychotic symptoms, dangerous or violent behavior, or a decline in functioning.

Eighty-one patients (53.6%) in the LAIs group and 672 (66.1%) in the oral antipsychotics group were rehospitalized within one year of discharge. Patients in the LAIs group had a significantly longer time to rehospitalization, a median of 257 days compared with a median of 115 days for those in the oral antipsychotics group. When reviewing the patients’ records, the researchers found that shorter hospitalizations and fewer hospitalizations prior to the study were also associated with a longer time between discharge and rehospitalization.

Lin and colleagues noted several limitations to their study, notably that the follow-up was only one year, and longer follow-up may reveal other differences between the two groups. Additionally, all patients were discharged from a single facility in Taiwan, so results may not be generalizable to other facilities and countries.

“In the future, further studies focusing on factors associated with risk of rehospitalization and effective interventions to prevent rehospitalization should be explored,” they wrote.

For related news, see the Psychiatric Services article “Comparison of Injectable and Oral Antipsychotics in Relapse Rates in a Pragmatic 30-Month Schizophrenia Relapse Prevention Study.”

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Wednesday, August 14, 2019

Refugees at Greater Risk of Developing Psychotic Disorders, Meta-Analysis Finds

The risk for schizophrenia and other psychotic disorders is higher among refugees than native populations and nonrefugee migrants, suggests a report published today in JAMA Psychiatry.

“Refugees do not migrate deliberately but are forced to migrate and have possibly faced traumatic experiences before and during migration,” wrote Lasse Brandt, M.D., of Charité-University Medicine Berlin and colleagues. Migration combined with separation from social networks, social exclusion and discrimination, limited access to medical care, poverty, and more may make refugees especially vulnerable to developing mental illness, they added.

Previous studies have pointed to migration as a risk factor for developing nonaffective psychoses, such as schizophrenia, schizoaffective disorder, and schizophreniform disorders. Brandt and colleagues wanted to know how the incidence of these mental illnesses in refugee migrants compared with incidence in both nonrefugee migrants and native groups in a host country.

Based on an analysis of nine studies published between 2004 and 2018, which included 540,000 refugees in Canada, Denmark, Norway, and Sweden, the researchers found that refugee migrants were 40% more likely to have a first diagnosis of nonaffective psychoses than nonrefugee migrants and 140% more likely than native populations of the host country.

“We believe that these findings highlight the need for psychiatric prevention strategies and outreach programs for refugees,” concluded Brandt and colleagues.

The researchers noted several study limitations; for example, eight of the nine studies were from Scandinavian countries, questioning whether the findings are applicable to other regions. Additionally, “despite the similarity in geographic location and study methods among included studies, their heterogeneity [across studies] was considerably high,” they wrote.

Nonetheless, in an accompanying editorial, Kristina Sundquist, M.D., Ph.D., of Lund University in Sweden noted, “because the risk of nonaffective psychoses in refugees was significantly increased (both compared with nonrefugee migrants and the native population) in countries with a generous welfare system and almost universal health care coverage, … refugees in other parts of the world may have even higher relative risks for several psychiatric disorders, including nonaffective psychoses.” She added, “The observed risk increases of nonaffective psychoses in refugees highlight the need for extended support, which may include psychiatric care specifically tailored for this vulnerable subgroup in the population. Support to refugees may also encompass other health-promoting efforts to prevent psychiatric disorders from occurring.”

For related information, see the Psychiatric News article “GWU Group Helps Train Refugee Aid Workers.”

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Tuesday, August 13, 2019

Youth Who Use E-Cigarettes May Be More Likely to Use Marijuana, Study Finds

Adolescents and young adults who use e-cigarettes are more likely to use marijuana, according to a meta-analysis published Monday in JAMA Pediatrics.

“These findings, which show a significant association between two psychoactive substances that have long-term deleterious effects on the brain, have important public health implications: Addressing [e-cigarette] use and doing so early may be an effective way of delaying onset of marijuana use,” Nicholas Chadi, M.D., M.P.H., of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital and colleagues wrote.

Chadi and colleagues searched several databases for studies comparing rates of marijuana use among youth aged 10 to 24 years with and without a history of e-cigarette use. They also searched through abstracts and reports from major substance use and tobacco prevention associations and conferences and summary reports on the health effects of e-cigarettes.

A total of 21 studies, including three longitudinal studies representing 14,364 participants and 18 cross-sectional studies representing 113,863 participants, were included in the meta-analysis.

The authors found that youth who used e-cigarettes were more than three times as likely to be using or have used marijuana. Additional analysis revealed e-cigarette users under 18 were more likely to use marijuana compared with e-cigarette users over 18.

“While the long-term health outcomes of using newer [electronic nicotine-delivery systems] devices is not yet well understood, e-cigarette liquids contain several known toxins. Chronic exposure accruing over a lifetime for individuals who initiate use early is a particular concern,” the researchers wrote. “It is well established that the younger the age at onset of substance use, the higher the likelihood of developing a substance use disorder later in life.”

For related information, see the Psychiatric News article “FDA Warns Some E-Cigarette Users Having Seizures, Particularly Youth.”

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Monday, August 12, 2019

Behavior Modification Found to Be Effective for Managing Pediatric Aggression

A behavior modification program that features positive and negative incentives reduced the use of psychotropic medications and/or physical interventions to manage agitated outbursts in children hospitalized for aggression, compared with a program that relied on verbal de-escalation techniques. The findings were published online by the Journal of the American Academy of Child & Adolescent Psychiatry.

“[O]ur data support the effectiveness of the [behavior modification program] and suggest that verbal attempts to calm the raging child can be counterproductive,” wrote Gabrielle Carlson, M.D., of the Renaissance School of Medicine at Stony Brook University and colleagues.

Carlson and colleagues assessed research and medical records of five cohorts of children admitted to Stony Brook’s 10-bed children’s psychiatric inpatient unit for aggressive behavior between 2008 and 2018. During this time, the facility transitioned away from a behavior modification program (BMP)—which involved collaborative problem-solving therapy coupled with positive rewards for good behavior and “time outs” for bad behavior—to reduce aggression. The unit switched to a program that used verbal de-escalation or distraction to talk children down from what the authors described as “intensely emotional situations.” Carlson and colleagues noted the switch was due to a perceived inability to provide enough incentives for good behavior as well as a belief that “time outs” were a form of physical restraint.

The final analysis included 347 children admitted during BMP use and 163 admitted during de-escalation use. The researchers found that the use of medications like sedatives or antipsychotics to reduce agitation was significantly lower when BMP was in use. “As needed” medical sedation was used 163 times per 1,000 patient-days when BMP was used compared with 483 times per 1,000 patient-days when de-escalation was used. The need for seclusion or physical restraint also was lower with BMP than with de-escalation (17 times versus 65 times, respectively, per 1,000 patient-days).

“Perhaps the increased attention given to the agitated child by continually talking to him/her, encouraging skill use, and sometimes giving children what they wanted to limit frustration inadvertently reinforced the unwanted behaviors,” wrote Carlson and colleagues as a possible explanation for why verbal de-escalation strategies increased the use of medication and/or restraint. They also suggested that under the de-escalation strategy children may have learned that aggression was a good way to avoid doing an unpleasant task, since staff sometimes let children get their way to calm them. However, the authors also noted the differences seen in outcomes between the two approaches may have been the result of the staff being less familiar with the technique. “It is possible that staff wasn’t adequately trained to execute de-escalation interventions correctly, biasing findings in favor of [BMP],” they wrote.

To read more about this topic, see the American Journal of Psychiatry article “Brain Mechanisms of Attention Orienting Following Frustration: Associations With Irritability and Age in Youths.”

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Friday, August 9, 2019

Clinicians Warned to ‘Be Alert’ to Ramifications of Conversion Therapy

Despite outspoken opposition to conversion therapy—practices that seek to change an individual’s sexual orientation or gender identity—by multiple professional medical organizations, only 18 states, Puerto Rico, and Washington, D.C., have banned conversion therapy for minors. As a result, it is estimated that more than 16,000 LGBTQ adolescents in the United States will undergo conversion therapy with a licensed health care professional by the time they reach 18 years of age, according to the Williams Institute at the UCLA School of Law.

In an article published yesterday in the New England Journal of Medicine, Carl G. Streed Jr., M.D., M.P.H., of Boston Medical Center and colleagues traced the history of the emergence of conversion therapy and later recognition by the medical community of its harmful effects. They cautioned clinicians to “be alert” to the needs of patients who may have received conversion therapy.

“Studies of adults who underwent conversion therapy earlier in life document a range of health risks,” Streed and colleagues wrote. Some of these health risks were highlighted by a 2018 study comparing LGBTQ young adults who had been encouraged to attend conversion therapy with those who had not, the authors noted. The study found youth whose parents or caregivers encouraged conversion therapy or reported being sent to therapists and religious leaders for conversion interventions were more likely to have depression, suicidal thoughts, suicidal attempts, less educational attainment, and less weekly income than those who had not been encouraged to seek or exposed to conversion therapy.

“Clinicians can be alert to the profile of a typical conversion-therapy participant. Patients involved in conversion therapy may not volunteer relevant information to a health care provider and may go out of their way to conceal their participation,” Streed and colleagues wrote. “Many survivors of conversion therapy will need treatment for posttraumatic stress disorder and post-religious trauma.”

Many medical professional organizations have acknowledged the risks of conversion therapy and oppose its use, the authors noted. Since 1998, APA has opposed any psychiatric treatment, such as “reparative” or conversion therapy, which is based upon the assumption that homosexuality is a mental disorder or that a patient should change his/her homosexual orientation. Other medical organizations to voice opposition to the use of conversion therapy include the AMA, the World Psychiatric Association, the American Psychological Association, the American Academy of Pediatrics, and the American College of Physicians.

“Beyond ending harmful practices [of conversion therapy], supporting the acceptance and inclusion of people of all gender identities, gender expressions, and sexual orientations is critical,” Streed and colleagues wrote. Clinicians should take steps to educate themselves about LGBTQ patients, including the ramifications of conversion therapy, they continued.

“According to a draft of the U.S. Joint Statement on Conversion Therapy, a consensus statement being prepared by more than a dozen health care organizations, medical officials should take into account developmental considerations for each stage of the lifespan when caring for patients and should be prepared to offer supportive therapies and provide accurate information and resources for all LGBTQ patients and their families,” they concluded. “We believe it is vital for clinicians to understand both the scientific and the ethical hazards of conversion therapy and appropriate responses for survivors and at-risk patients and to help create supportive environments for all LGBTQ persons.”

For related information, see the Psychiatric News article “SAMHSA Report Calls for End to ‘Conversion’ Therapy for Youth” and APA’s most recent position statement on conversion therapy.

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Thursday, August 8, 2019

Time for Action on Firearm Violence Is Now, Says APA

APA on Wednesday joined six other physician and health professional organizations in calling for action to address the public health epidemic of firearm-related injury and death.

“Our nation is in the midst of an epidemic of firearm-related injuries and deaths, and we must treat this as a public health crisis,” APA President Bruce Schwartz, M.D., said in a press release. “We see the long-lasting mental health impact firearm-related violence and injury has on our patients every day, and it is time for us to come together as a nation to address this epidemic.”

The call to action was published yesterday in the Annals of Internal Medicine. In the article, Schwartz and leaders from the AMA, American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Surgeons, and the American Public Health Association outlined several specific policy recommendations to prevent firearm-related injury and death in the United States. These recommendations include the following:

  • Comprehensive criminal background checks for all firearm sales.
  • Further research into the causes and consequences of firearm injury and death.
  • Improved access to mental health care and caution against broadly including all individuals with a mental health disorder in a category of individuals prohibited from purchasing firearms.
  • Removal of barriers to physician counseling of patients about the health risks of firearms.
  • Reasonable laws and regulations governing firearms with high-capacity magazines and other features for rapid firing.
  • Enactment of extreme risk protection order laws, which allow families and law enforcement to petition a judge to temporarily remove firearms from individuals at imminent risk for using them to harm themselves or others.

“Across the United States, physicians have daily, firsthand experience with the devastating consequences of firearm-related injury, disability, and death. We witness the impact of these events not only on our patients, but also on their families and communities,” they wrote. “As with other public health crises, firearm-related injury and death are preventable. The medical profession has an obligation to advocate for changes to reduce the burden of firearm-related injuries and death on our patients, their families, our communities, our colleagues, and our society.”

“The house of medicine is unified in this call,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., in the press release. “The time for action is now.”

For related information, see the Psychiatric News articles “Most Americans Agree That Gun Violence Is Public Health Problem, Call for Action” and “Gun Violence: The Parkland Survivors and the End of Learned Helplessness?

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Wednesday, August 7, 2019

College Program May Change Student Attitudes About Mental Illness

Years after the launch of a campus program to reduce stigma around mental illness at Indiana University, some college students there reported less prejudice toward people with mental illness, according to a study in the Journal of the American Academy of Child & Adolescent Psychiatry. The students also reported a greater willingness to talk about mental illness after exposure to the program.

“A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, develop the next generation of mental health leaders, and potentially reduce societal levels of stigma in the long run,” wrote Bernice A. Pescosolido, Ph.D., of Indiana University (IU) and colleagues.

The U(niversity) Bring Change to Mind (UBC2M) program is a student-led effort to create “safe and stigma-free zones” on college campuses that was developed and launched in 2014. Through UBC2M, Indiana University students led such activities as biweekly club meetings; academic and on-campus events, including guest and student speakers who talked about personal experiences with mental illness; an annual campus anti-stigma campaign competition; and an annual UBC2M gala.

To examine the impact of the program, Pescosolido and colleagues invited first-year students to complete a web-based survey on stigma. The survey asked students to consider how strongly they agreed with statements reflecting prejudice toward people with mental illness, such as the following: “I am frightened to be around persons with a history of mental illness” (general prejudice) and “Students who have a history of mental illness should not be admitted to IU” (college-specific prejudice). The students were asked to complete the web-based survey again during their third year. A total of 1,193 students completed both waves of the survey.

Significant changes in stigma occurred, on average, for about 11% to 14% of the population, the authors reported. Student participation in multiple UBC2M events was associated with reductions in both general and college-specific prejudice toward people with mental illness; these reductions were the greatest in respondents who reported participation in four or more UBC2M-sponsored events since the initial survey.

There was no significant change in general or college-specific prejudice toward people with mental illness in respondents who reported only general awareness of UBC2M (for example, familiarity with program logo and/or exposure to program through social media). However, regardless of the respondents’ level of active involvement with UBC2M activities, those aware of the program reported feeling more open to talk about mental health problems and stigma issues on campus when surveyed during their third year.

“Our finding that active and passive engagement predict more favorable normative beliefs about [mental health] (e.g., perceptions of campus mental health culture, mental health conversation partners) suggests that the program may also shift the larger campus culture [toward greater understanding of mental illness]. Because normative beliefs have a powerful effect on individuals’ attitudes and beliefs, this shift may lead to more widespread and potentially longer lasting stigma reduction.”

For related information, see the Psychiatric News article “Anxious, Stressed, and Lonely College Students Seek Out Campus MH Services” and the Psychiatric Services article “Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007–2017).”

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Tuesday, August 6, 2019

Psychotic Symptoms in Childhood May Increase Risk of Poor Mental Health in Young Adulthood

Psychotic symptoms in childhood may indicate an increased risk for mental health problems and poor social outcomes in young adulthood, according to a study in Schizophrenia Bulletin.

Antonella Trotta, Ph.D., of King’s College London and colleagues analyzed data from the Environmental Risk Longitudinal Twin Study to determine whether psychotic symptoms at age 12 were associated with mental, social, and physical outcomes at age 18. As part of this study, 1,116 pairs of same-sex twins were asked at age 12 whether they had experienced psychotic symptoms such as delusions and hallucinations. The participants were interviewed again at age 18 to assess a variety of factors, including their physical health, symptoms of mental illness, life satisfaction, and educational attainment.

The researchers found that children who had psychotic symptoms at age 12 were more likely to have psychotic symptoms, depression, or anxiety at age 18 than their peers who did not have psychotic symptoms at age 12. They were also more likely to have attempted suicide or engaged in self-harm, be obese, smoke cigarettes, be lonely, and report a lower quality of life.

When the researchers compared the twins within families with each other, however, they found “that most of the associations between childhood psychotic symptoms and poor outcomes in young adulthood were explained by familial factors suggesting that early psychotic phenomena could not be considered to be causing later problems.” The exceptions were psychotic symptoms, loneliness, and the overall risk of mental health problems in young adulthood, which were still strongly associated with psychotic symptoms in childhood.

“This finding does not undermine the prognostic significance of childhood psychotic symptoms but indicates that merely reducing the occurrence of these symptoms will not improve mental health and functional outcomes in young adulthood,” the researchers wrote. “These early [psychotic] symptoms may, therefore, act as a useful way of identifying children who are at risk for an array of poor outcomes in young adulthood and who may benefit from preventive interventions. However… such interventions would need to be targeted at [family-wide risk] factors rather than the psychotic symptoms themselves.” 

For related news, see the Psychiatric News article “Hallucinations Can Be Marker for Variety of Psychiatric Disorders in Youth.”

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Monday, August 5, 2019

Adding Fluoxetine to CBT May Not Further Reduce Depressive Symptoms in Youth With MDD

A combination therapy of fluoxetine and cognitive-behavioral therapy (CBT) is not superior to CBT alone for treating teens and young adults with major depression, according to a study published in Lancet Psychiatry.

“[W]e did not find evidence that adding fluoxetine to CBT was beneficial for reducing depressive symptoms,” wrote Christopher Davey, M.B.B.S., Ph.D., of Orygen, the National Centre of Excellence in Youth Mental Health in Australia, and colleagues. “Our results show that adding fluoxetine to CBT might be more effective for treating anxiety symptoms than for depressive symptoms.”

Davey and colleagues conducted a 12-week randomized trial involving 153 participants aged 15 to 25 with moderate-to-severe major depression (score of 20 or higher on the Montgomery-Åsberg Depression Rating Scale, or MADRS). All participants received weekly 50-minute CBT sessions as well as daily fluoxetine (up to 40 mg/day) or placebo pills. The researchers evaluated the participants’ depressive and anxiety symptoms, social functioning, quality of life, and suicidal thoughts every four weeks.

After 12 weeks, there was no statistical difference between the two study groups in terms of depression symptoms; MADRS scores decreased by 15.1 points among patients receiving CBT plus fluoxetine and 13.7 points among patients receiving CBT plus placebo. However, participants in the fluoxetine group showed statistically significant improvements in anxiety symptoms, as measured by the Generalized Anxiety Disorder 7-item scale (GAD-7); GAD-7 scores decreased by 5.3 points in the fluoxetine group compared with 3.2 points in the placebo group.

During the study, there were five suicide attempts in the CBT plus placebo group and one in the CBT plus fluoxetine group; all but one of these attempts were by participants 18 and older. In contrast, there were almost twice as many instances of nonsuicidal injury among participants taking fluoxetine compared with placebo, with most incidents occurring in participants under 18.

“The results of this study will probably discourage the combined use of CBT and medication as a first-line approach to treating youths with moderate-to-severe depression,” wrote Benedetto Vitiello, M.D., of the University of Turin, Italy, in an accompanying editorial. “Instead, a stepped-treatment approach, with initial monotherapy followed by the addition of another modality in case of insufficient response or to prevent relapse, seems to be a more reasonable use of resources.”

For more information on a related topic, see the Psychiatric News article “Adding Paroxetine May Not Improve CBT for Social Anxiety.”

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Friday, August 2, 2019

Not Just Women: Study Finds Weight Stigma May Be Harmful to Men, Too

Experiencing stigma associated with being overweight may have negative effects on men’s health and mental health, signifying a need to pay more attention to men in an area of research and treatment that usually focuses on women, say researchers in a study published in Obesity.

“More than 20 studies examining health effects of weight stigma in the past five years alone have been limited to women, but very few studies to date have been limited to men,” Mary S. Himmelstein, Ph.D., and colleagues at the University of Connecticut wrote.

In the study, more than 1,750 overweight men with an average body mass index of approximately 27 completed surveys about their experiences of weight-based stigma, such as whether they were teased, treated unfairly, or felt they were discriminated against because of their weight, and how much they internalized these experiences (blamed or stereotyped themselves because of their weight). The surveys also probed whether they engaged in such behaviors such as binge eating and dieting, whether the men had symptoms of depression, and the men’s sense of their health and well-being.

The researchers found that both experienced and internalized stigma were associated with depressive symptoms and dieting behaviors. Experienced weight stigma was associated with binge eating, while internalized stigma was associated with low self-rated health.

“Although there has been increasing attention to the harmful effects of weight stigma, research on weight stigma in men is often neglected,” the researchers wrote. “Our study suggests the need for increased attention to men, both in weight stigma research and among health professionals treating men for a variety of health conditions in which weight stigma may play a contributing role.”

For related news, see the Psychiatric News article “Researchers Examine Link Between Mood, Food, and Obesity.”

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Thursday, August 1, 2019

Clozapine Found More Effective Than Other Antipsychotics in Real-World Settings

Patients with severe schizophrenia treated with clozapine experience greater symptom improvements and fewer hospitalizations than those given other second-generation antipsychotics, according to a meta-analysis of population-level studies published yesterday in JAMA Psychiatry. Clozapine use also was associated with a greater risk of cardiometabolic problems such as obesity and diabetes, noted Takahiro Masuda, Ph.D., of the Zucker Hillside Hospital in Glen Oaks, N.Y., and colleagues.

Clozapine has long been considered the best pharmacological option for patients with treatment-resistant schizophrenia. However, findings from recent randomized clinical trials (RCTs) have suggested that clozapine may not be superior to other second-generation antipsychotics.

“Because participants in RCTs do not necessarily represent real-world patients or settings, the results from RCTs cannot readily be generalized to clinical practice,” Masuda and colleagues wrote. To address this, Masuda and colleagues conducted a meta-analysis of 63 studies involving antipsychotic use in cohort studies, which are more reflective of real-world practice.

The authors found that even though patients taking clozapine were generally more severely ill than those taking other antipsychotics, clozapine use was associated with an 18% reduced risk of hospitalization and a 27% reduced risk of discontinuing treatment. Head-to-head analyses between clozapine and five other antipsychotics (amisulpride, aripiprazole, olanzapine, quetiapine, and risperidone) suggested clozapine was better at reducing hospital risk than the other antipsychotics except for olanzapine, and it was better tolerated than the other antipsychotics except for aripiprazole and amisulpride.

Patients taking clozapine also reported greater reductions in the severity of their illness, as assessed by the Clinical Global Impressions scale, compared with patients taking other antipsychotics. However, patients taking clozapine did experience greater increases in body weight, blood pressure, and triglyceride levels, as well as an increased risk of diabetes.

“This comprehensive meta-analysis of cohort studies, reflecting clinical practice more than RCTs, found clozapine to be associated with better effectiveness outcomes than [other second-generation antipsychotics], despite more severely ill patients being treated with clozapine, but with significantly greater risk of cardiometabolic adverse outcomes, both of which require consideration when making treatment choices,” the authors concluded.

To read more about clozapine effectiveness, see the Psychiatric News article “Clozapine, LAI Antipsychotics Found Best at Preventing Relapse.”

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