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Real-world effectiveness of clozapine for intellectual disability: Results from a mirror-image and a reverse-mirror-image study

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@article{1fde06dade74405693300223a2a7cd4a,
title = "Real-world effectiveness of clozapine for intellectual disability: Results from a mirror-image and a reverse-mirror-image study",
abstract = "BACKGROUND: Comorbid mental illness is common in patients with intellectual disability. Antipsychotics are widely used for these conditions, but the effect of clozapine remains largely unknown.AIMS: We aimed to investigate the effectiveness of clozapine on naturalistic outcomes in patients with intellectual disability.METHODS: By combining the national health registers, we identified all patients in Denmark with intellectual disability initiating clozapine treatment during the period 1996-2012. We used a mirror-image model to test whether initiation of clozapine treatment was associated with reduction in psychiatric admissions and inpatient days, reduction in the number of individuals performing intentional self-harm or overdose, and less frequent use of concomitant psychopharmacological treatment. Similar outcome measures were used in a reverse mirror-image model to investigate the effects of clozapine termination.RESULTS: A total of 405 patients with intellectual disability redeemed clozapine. After initiation of clozapine the number of psychiatric admissions were reduced by 0.65 admissions (95{\%} CI: 0.31-1.00) and the inpatient days were reduced by 67.2 days (95{\%} CI: 51.2-83.3), with a similar decrease for patients with intellectual disability without psychiatric comorbidity. Clozapine treatment was not found to reduce the number of individuals with intentional self-harm, incidents of overdose, or the use of concomitant psychotropics. In cases where clozapine treatment was terminated, the number of psychiatric admissions increased by 0.57 admissions (95{\%} CI: 0.01-1.12).CONCLUSION: This nationwide study, which is the largest to date, suggests that treatment with clozapine is associated with a reduction in psychiatric admissions and inpatient days in patients with intellectual disability. Further studies evaluating the effects of clozapine in patients with intellectual disability are warranted.",
author = "Christopher Rohde and Rikke Hilker and Dan Siskind and Jimmi Nielsen",
year = "2018",
month = "11",
doi = "10.1177/0269881118783322",
language = "English",
volume = "32",
pages = "1197--1203",
journal = "Journal of Psychopharmacology",
issn = "0269-8811",
publisher = "Sage Science Press (UK)",
number = "11",

}

RIS

TY - JOUR

T1 - Real-world effectiveness of clozapine for intellectual disability

T2 - Results from a mirror-image and a reverse-mirror-image study

AU - Rohde, Christopher

AU - Hilker, Rikke

AU - Siskind, Dan

AU - Nielsen, Jimmi

PY - 2018/11

Y1 - 2018/11

N2 - BACKGROUND: Comorbid mental illness is common in patients with intellectual disability. Antipsychotics are widely used for these conditions, but the effect of clozapine remains largely unknown.AIMS: We aimed to investigate the effectiveness of clozapine on naturalistic outcomes in patients with intellectual disability.METHODS: By combining the national health registers, we identified all patients in Denmark with intellectual disability initiating clozapine treatment during the period 1996-2012. We used a mirror-image model to test whether initiation of clozapine treatment was associated with reduction in psychiatric admissions and inpatient days, reduction in the number of individuals performing intentional self-harm or overdose, and less frequent use of concomitant psychopharmacological treatment. Similar outcome measures were used in a reverse mirror-image model to investigate the effects of clozapine termination.RESULTS: A total of 405 patients with intellectual disability redeemed clozapine. After initiation of clozapine the number of psychiatric admissions were reduced by 0.65 admissions (95% CI: 0.31-1.00) and the inpatient days were reduced by 67.2 days (95% CI: 51.2-83.3), with a similar decrease for patients with intellectual disability without psychiatric comorbidity. Clozapine treatment was not found to reduce the number of individuals with intentional self-harm, incidents of overdose, or the use of concomitant psychotropics. In cases where clozapine treatment was terminated, the number of psychiatric admissions increased by 0.57 admissions (95% CI: 0.01-1.12).CONCLUSION: This nationwide study, which is the largest to date, suggests that treatment with clozapine is associated with a reduction in psychiatric admissions and inpatient days in patients with intellectual disability. Further studies evaluating the effects of clozapine in patients with intellectual disability are warranted.

AB - BACKGROUND: Comorbid mental illness is common in patients with intellectual disability. Antipsychotics are widely used for these conditions, but the effect of clozapine remains largely unknown.AIMS: We aimed to investigate the effectiveness of clozapine on naturalistic outcomes in patients with intellectual disability.METHODS: By combining the national health registers, we identified all patients in Denmark with intellectual disability initiating clozapine treatment during the period 1996-2012. We used a mirror-image model to test whether initiation of clozapine treatment was associated with reduction in psychiatric admissions and inpatient days, reduction in the number of individuals performing intentional self-harm or overdose, and less frequent use of concomitant psychopharmacological treatment. Similar outcome measures were used in a reverse mirror-image model to investigate the effects of clozapine termination.RESULTS: A total of 405 patients with intellectual disability redeemed clozapine. After initiation of clozapine the number of psychiatric admissions were reduced by 0.65 admissions (95% CI: 0.31-1.00) and the inpatient days were reduced by 67.2 days (95% CI: 51.2-83.3), with a similar decrease for patients with intellectual disability without psychiatric comorbidity. Clozapine treatment was not found to reduce the number of individuals with intentional self-harm, incidents of overdose, or the use of concomitant psychotropics. In cases where clozapine treatment was terminated, the number of psychiatric admissions increased by 0.57 admissions (95% CI: 0.01-1.12).CONCLUSION: This nationwide study, which is the largest to date, suggests that treatment with clozapine is associated with a reduction in psychiatric admissions and inpatient days in patients with intellectual disability. Further studies evaluating the effects of clozapine in patients with intellectual disability are warranted.

U2 - 10.1177/0269881118783322

DO - 10.1177/0269881118783322

M3 - Journal article

VL - 32

SP - 1197

EP - 1203

JO - Journal of Psychopharmacology

JF - Journal of Psychopharmacology

SN - 0269-8811

IS - 11

M1 - 32

ER -

ID: 54977649