Demographic and clinical characteristics of patients who recommence clozapine following therapy interruptions.

OBJECTIVE: The proportion of patients who recommence clozapine after cessation, the time taken to resume clozapine post-cessation, and distinguishing demographic and clinical characteristics of this group have been poorly researched. We evaluated these in the current study. METHOD: We retrospectively extracted selected demographic and clinical variables and clozapine treatment interruption and recommencement data up to December 2018 of a cohort of 458 patients who first commenced clozapine between 2006 and 2016. The study was conducted at three Australian health services. RESULTS: Of the 310 (69%) patients who had at least one interruption of clozapine treatment, 170 (54.8%) did not resume clozapine, and 140 (45.2%) recommenced it after the first interruption. More than half of those who recommenced did so within a month and 80% by 12 months. Cox regression analysis revealed that age was significantly associated with recommencement, with a 2% decrease in the likelihood of restarting after an interruption for each year later that clozapine was initially commenced (HR = 0.98 95%CI: 0.97, 0.997, p = 0.02). Those who ceased clozapine due to adverse effects were less likely to restart than those who ceased due to noncompliance (HR = 0.63 95%CI: 0.41, 0.97, p = 0.03). More time on clozapine prior to interruption increased the likelihood of restarting it, with each additional month on clozapine increasing this likelihood by 1% (HR = 1.01 95%CI: 1.01, 1.02, p < 0.001). CONCLUSION: If the distinguishing demographic and clinical characteristics of the group identified in this study are corroborated through further research, this could further validate the need to identify treatment resistance and commence clozapine early in people with schizophrenia and provide appropriate interventions to those more at risk of permanent discontinuation of clozapine.

Mental health recovery and physical health outcomes in psychotic illness: Longitudinal data from the Western Australian survey of high impact psychosis catchments.

OBJECTIVE: There is a dearth of longitudinal data on outcomes in prevalent cases of psychotic illness across a range of ages and levels of chronicity. Our aim was to describe changes over time in mental and physical health outcomes, as well as patterns of service utilisation that may have influenced outcomes, in a representative prevalence sample of 641 Western Australians with a psychotic illness who, at Wave 1, were part of the National Survey of High Impact Psychosis. METHODS: In Wave 1 (2010, 2012), a two-phase design was employed to ensure representativeness: Phase 1 psychosis screening took place in public mental health and non-government organisation services, while, in Phase 2, a randomised sample was interviewed. In Wave 2, 380/641 (59%) of participants were re-interviewed, with interviews staggered between 2013 and 2016 (follow-up time: 2.3-5.6 years). Data collection covered mental and physical health, functioning, cognition, social circumstances and service utilisation. Mental health outcomes were categorised as symptomatic, functional and personal recovery. Physical health outcomes covered metabolic syndrome and its component criteria. RESULTS: In mental health, there were encouraging improvements in symptom profiles, variable change in functional recovery and some positive findings for personal recovery, but not quality of life. Participants ranked physical health second among challenges. Metabolic syndrome had increased significantly. While treatment for underlying cardiovascular risk conditions had improved, rates of intervention were still very low. More people were accessing general practices and more frequently, but there were sharp and significant declines in access to community rehabilitation, psychosocial interventions and case management. CONCLUSION: Although we observed some positive outcomes over time, the sharp decline in access to evidence-based interventions such as community rehabilitation, psychosocial interventions and case management is of great concern and augurs poorly for recovery-oriented practice. Changes in service utilisation appear to have influenced the patterns found.

The physical health Wellness Clinic model of care for patients with mental health issues who are 'hard to engage'.

OBJECTIVE: People with chronic and severe mental health issues die 15-25 years earlier than people in the general population - the main reason for this is poor physical health. An innovative treatment model for the management of primary care within a mental health service setting for 'hard to engage' patients is presented. CONCLUSION: The Wellness Clinic model provides the final level of care, where individuals who are at risk will receive a thorough physical health check and be referred for any additional tests and scans that are needed ensuring that any health issues are addressed. Ongoing monitoring and treatment occurs with the overall aim of reintegrating individuals back into the community through linking them in with community GPs.

The Wellness Clinic: A retrospective Quasi-experimental, longitudinal study of physical health support in an Australian mental health service setting.

The poor physical health of patients with severe/chronic mental illness is now well-known, yet little has been done to address the issue. Adverse medication effects, lifestyle, and social factors can all contribute to high morbidity and mortality rates when compared to the general population. To arrest poor physical health, a Wellness Clinic within a mental health hospital was developed to provide continuity of care when patients were discharged from the hospital. A retrospective, within-subjects, quasi-experimental, longitudinal time-series study was conducted analysing the demographics and physical health parameters of 57 patients who remained with the service over a four and a half year time period. Assessments were taken at baseline, 12, 24, and 36 months for each individual. Despite increasing levels of psychotropic and other health medication over time, physical health parameters were generally held stable for most measures across the four time periods. HDL-C levels were significantly improved between baseline and 36 months. This stability over time suggests that ongoing assessment, monitoring, and treatment is necessary to arrest the downward trajectory of poor physical health in mental health and opens the door for future research to invest in interventions to run alongside the Wellness Clinic and improve patient physical health.