Clozapine use at a specialised psychiatric hospital in Johannesburg

South African Journal of Psychiatry

Field Value
Title Clozapine use at a specialised psychiatric hospital in Johannesburg
Creator Ord, Katherine L. Marais, Belinda
Subject Psychiatry clozapine; treatment-resistance; schizophrenia; side effect; treatment discontinuation; polypharmacy; South Africa.
Description Background: Clozapine is the gold standard medication for treatment-resistant psychosis, with robust evidence supporting its efficacy in multiple symptom domains. However, clozapine’s side effect profile contributes to its underutilisation and discontinuation.Aim: This study aimed to explore the magnitude of clozapine use and describe factors that impact on its effective use among in-patients.Setting: Tara Hospital, a specialised psychiatric hospital in Johannesburg.Methods: This was a retrospective, cross-sectional file review of clozapine-treated patients admitted over the 2-year study period. Data variables included: demographics, clinical information, discharge prescription, clozapine-related side effects and details of clozapine discontinuation, where applicable.Results: A cohort of 33.2% of patients from Tara’s biological wards received a trial of clozapine. Participants experienced anti-cholinergic clozapine-related side effects that included weight gain (79.5%), tachycardia (35.2%) and constipation (35.2%). Clozapine was discontinued in 13.7% of participants, and no life-threatening side effects or deaths occurred. Significantly more use of flupenthixol decanoate (64.3% vs. 30.7%; p = 0.0322) and anticholinergics (35.7% vs. 11.4%; p = 0.0474) occurred in the clozapine-discontinued group. Polypharmacy rates were high for psychiatric and non-psychiatric medications.Conclusion: One-third of patients received clozapine trials, most of whom continued at discharge. Although side effects occurred frequently, life-threatening side effects did not. Clozapine monitoring protocols, side effect rating scales, pre-emptive management of side effects, lifestyle interventions and clinician education may improve outcomes of clozapine use. The use of plasma clozapine levels may be beneficial.Contribution: This study expands our limited knowledge regarding current clozapine prescribing trends in South Africa.
Publisher AOSIS
Contributor Department of Witwatersrand Tara Hospital
Date 2023-04-04
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Retrospective; Cross-sectional file review; Quantitative research
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajpsychiatry.v29i0.1999
Source South African Journal of Psychiatry; Vol 29 (2023); 9 pages 2078-6786 1608-9685
Language eng
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Coverage South Africa; Gauteng; Africa 1 January 2018 - 31 December 2019 Male and Female; Psychiatric in-patient; Clozapine users and Clozapine-discontinued; Age 18 and older
Rights Copyright (c) 2023 Katherine L. Ord, Belinda Marais