
Real-World Outcomes in the Management of Refractory Psychosis
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Overview
Clozapine is the only medication approved for refractory schizophrenia, yet it is underused. Further, for minimal response to clozapine treatment, there is little guidance on the next step. Here, review outcomes data for inpatients with refractory psychosis.
Read the whole article at psychiatrist.com here:
Real-World Outcomes in the Management of Refractory Psychosis
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
Psychiatrists
Learning Objectives
Initiate, optimize, and monitor treatment for refractory psychosis
CME Background
Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.
CME Objective
After studying this article, you should be able to:
- Initiate, optimize, and monitor treatment for refractory psychosis
Statement of Need and Purpose
Nearly one-third of patients with schizophrenia have TRS, which presents a significant burden on patient quality of life as well as on health care utilization. Guidelines recommend clozapine be offered to patients with TRS; however, it is grossly underprescribed by clinicians despite evidence of its efficacy. Barriers to the use of clozapine include concerns about serious side effects and lack of patient adherence, service fragmentation, the challenge of recognizing TRS, and inadequate training to using the medication. Clinicians need education on how to better identify patients who could benefit from clozapine, on initiating and monitoring clozapine, and on strategies for incomplete response to clozapine.
Release, Expiration, and Review Dates
This educational activity was published in September 2019 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2021. The latest review of this material was August 2019.
Disclosure of off-label usage
The authors have determined that, to the best of their knowledge, clozapine is the only medication approved by the US Food and Drug Administration for treatment-resistant schizophrenia.
Funding/support
No direct funding was provided for this research.
Disclaimer
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Faculty Affiliation
Amir Krivoy, MD*
National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; and Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
Dan Joyce, MBBS, MRCPsych, PhD
Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
Derek Tracy, MBBS, MSc, FRCPsych
Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom, and Oxleas NHS Foundation Trust, Green Parks House, Orpington, Kent, London, United Kingdom
Fiona Gaughran, MD, FRCPsych, FRCPI, FRCP
National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom, and Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
James MacCabe, MBBS, FRCPsych, PhD
National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom, and Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
John Lally, MBBS, MSc, MRCPsych
Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent’s University Hospital, Dublin, Ireland
Eromona Whiskey, BPharm, MCMHP, MRPharmS
National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom, and Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
S. Neil Sarkar, MBBS, MRCPsych
Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom, and Central and North West London NHS Foundation Trust, London, United Kingdom
Sukhwinder S. Shergill, MBBS, FRCPsych, PhD
National Psychosis Service, South London, and Maudsley NHS Foundation Trust, London, United Kingdom, and Department of Psychosis Studies, the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
*Corresponding author: Amir Krivoy, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, PO63, De Crespigny Park, London SE5 8AF, UK (Amir.krivoy@kcl.ac.uk).
Financial Disclosure
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.
Dr Gaughran has received honoraria for advisory work and lectures or Continuing Medical Education activity support from Roche, Bristol-Myers Squibb, Lundbeck, Otsuka, Janssen, and Sunovion; is a collaborator on a National Health Service (NHS) Innovations project co-funded by Janssen; and has a family member with professional links, including shares, to Lilly and GlaxoSmithKline. Dr Shergill is supported by a European Research Council Consolidator Award (#311686). This study represents independent research partly funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity. Drs Krivoy, Joyce, Tracy, MacCabe, Lally, and Sarkar and Mr Whiskey have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation