Tag: clozapine

Reading of the Week: Antipsychotics – the New, the Old & the Patient Experience, with Papers from JAMA Psych, BJP and Schiz Bulletin

October 10, 2024 /

From the Editor

“FDA approves a novel drug for schizophrenia, a potential ‘game changer’”

– The Washington Post

“Will ‘Game Changer’ Antipsychotic Live Up to the Hype?”

– Medscape

Two weeks ago, for the first time in decades, the FDA approved an antipsychotic for schizophrenia with a novel mode of action. What does the data show for this medication, xanomeline-trospium chloride? Is it a “game changer” as some headlines suggest? 

In the first selection, Dr. Inder Kaul (of Karuna Therapeutics) and his co-authors report on a double-blind, randomized, placebo-controlled trial that was published in JAMA Psychiatry. 256 people with schizophrenia were given the antipsychotic or the placebo and followed for five weeks. “Xanomeline-trospium was efficacious and well tolerated in people with schizophrenia experiencing acute psychosis.” We consider the study and its implications.

In contrast to this week’s first selection, the second selection looks at an older antipsychotic: clozapine. Drawing on Canadian databases, Lloyd Balbuena (of the University of Saskatchewan) and his co-authors put the risks and benefits of this medication in a new light in a paper for The British Journal of Psychiatry. They analyzed data on admissions and adverse events, with almost 50 000 participants. “Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.”

And in the third selection, Susan Weiner writes about antipsychotics for Schizophrenia Bulletin. She discusses her first psychotic break, her long journey, and her ultimate recovery. In a personal essay, she also describes the connection she made with her psychiatrist and the medication that transformed her life. “The right medicine for the right person can produce sanity like a miracle drug, and all is once again bright.”

DG

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Reading of the Week: CBT vs Mindfulness for Prolonged Grief Disorder – the New JAMA Psych Study; Also, Wildman on Her Grief, and Clozapine & MedEd

July 11, 2024 /

From the Editor

She still wears black. She mourns her partner’s death every day. Despite the passing years, she can’t seem to move forward. DSM-5-TR includes prolonged grief disorder, which has sparked controversy, but it explains well my patient’s complicated bereavement.

What’s evidenced for treatment? Is CBT superior to mindfulness? Richard A. Bryant (of the University of New South Wales) and his co-authors try to address these questions in a new JAMA Psychiatry paper. They describe a randomized clinical trial involving 100 adults offered CBT or mindfulness-based cognitive therapy. “In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy.” We consider the paper and its implications.

In the second selection, Sarah Wildman, a writer and editor, discusses her daughter’s death in an essay for The New York Times. She is candid about her grief. She talks about the passage of time, small things like calendars, and, yes, signs – her daughter promised that if she sees a red fox, it will be her. “I wonder if I should keep every item of clothing I can picture Orli in, I wonder what she would say about each movie I see, each book I read.”

In the third selection, Dr. Theodore R. Zarzar (of the University of North Carolina) emphasizes the importance of clozapine in the treatment of patients with schizophrenia. In his JAMA Psychiatry Viewpoint, he argues for incorporating clozapine proficiency into medical education. “Clozapine initiation can be conceptualized as the community psychiatric equivalent of a procedural skill and deserves the mentorship, knowledge acquisition, and practice that learning a procedure entails.”

DG

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Reading of the Week: Clozapine & Neutropenia – the new Lancet Psych Paper; Also, a Letter to the Editor and Bialik on Mental Health

January 18, 2024 /

From the Editor

Clozapine is special.

Almost seven decades after its release, that statement – from a new Lancet Psychiatry Editorial – remains true. Clozapine is the best antipsychotic for those who are treatment refractory in their schizophrenia. But there is the risk of potentially life-threatening neutropenia. And so its use is clunky, with much blood work and monitoring, off-putting to some who would benefit from this medication.

Are we too cautious with clozapine? In the first selection, Dr. Korinne Northwood (of The University of Queensland) and her co-authors consider that question in a new Lancet Psychiatry paper. Drawing from a major clozapine database for Australia and New Zealand patients, they analyzed 32 years of data involving 2.6 million blood tests and looked at neutropenic events. “Our results support greater flexibility in prescribing of clozapine and a more balanced approach to risk…” We review the paper and mull its clinical implications.

Australia: cool architecture and good clozapine data

In the second selection, in a letter to the editor, Clement Ma and Dr. Peter Szatmari (both of the University of Toronto) write about the recent MST vs. ECT paper from JAMA Psychiatry. They offer some hesitation on the authors’ wording: “a non-significant result in a superiority trial does not imply that the two treatments are equivalent.”

And in the third selection, actress and former Jeopardy! host Mayim Bialik writes personally about her mental health problems for Trend Magazine. She describes the challenges of getting help and her decision to speak out. She also notes the societal shift in thinking about mental illness. “[S]haring our own personal struggles is not a sign of weakness; it is a sign of strength. We all want to feel better, live better, and experience more joy and less suffering.”

DG

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Reading of the Week: Clozapine Prescribing & Demographics; Also, HBR on Equity in Telemedicine, and Eichler on Her Uncle & His Disappearances

October 21, 2021 /

From the Editor

Is clozapine prescribing effected by demographics?

In the first selection, from Psychiatric Services, Natalie Bareis (of Columbia University) and her co-authors consider medication prescriptions for those with psychotic disorders, drawing on US Medicaid data. “Our results indicate significant variation across states and among racial-ethnic groups in prescription patterns of six types of psychotropic medications, even after we had adjusted for multiple patient factors.” Indeed, they find that clozapine is much more commonly prescribed for those who are White. We consider the paper and its implications.

unknownClozapine: a simple molecule but complicated availability in the US?

In the second selection, Dr. Jonathan Rogg (of the University of Texas) and his co-authors consider equity and telemedicine. In a paper for the Harvard Business Review, they describe the services offered in a low-income area of Texas, and the lessons learned. “The Covid-19 pandemic has forced a rapid evolution in technology with the potential to help the most disadvantaged patients. Our experience during the pandemic has demonstrated that telemedicine can overcome access-related challenges faced by indigent populations. By allowing them to access care in their homes or even their jobs, it can help them address health issues expeditiously with minimal disruption to their lives.”

Finally, in the third selection from The Globe and Mail, writer Leah Eichler writes about her uncle, who probably had an undiagnosed mental illness. She writes about his disappearances and erratic behaviour. “We like to believe our relationships are solid, that love is somehow inextricably linked to permanence. Missing our loved ones, if anything, highlights how impermanent even our closest relationships can be.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

June 22, 2017 /

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

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Reading of the Week: Doing Things Differently – Clozapine and More

September 1, 2016 /

From the Editor

“When a Cape Breton cousin of mine was hospitalized at the main asylum for Nova Scotia in the 1940s with psychotic symptoms, his sister told me the family received a phone call from the treating physician telling them to give up all hope for their brother’s future.”

In his new book written with Dr. Pier Bryden, Dr. David Goldbloom – past Chair of the Mental Health Commission of Canada and Senior Medical Advisor of the Centre for Addiction and Mental Health – recalls the story.

Psychiatry is so much better today.

But there is room for much improvement. Uneven outcomes. Provider-focused care. Can we do things differently?

New approach, better results?

This week, we look at a blog published by HealthAffairs.org, considering the use of clozapine for people with schizophrenia. Dr. Adam Rose, drawing on the research, including his own research, wonders why we don’t use more of this effective treatment.

Then, turning to The Globe and Mail, we look at the life and death of Dr. Kate Granger – a physician who has challenged us health care providers to be more compassionate.

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