Is antipsychotic augmentation associated with improved functioning in patients on clozapine?

OBJECTIVE: We aimed at exploring the relationship between functional outcomes in patients on clozapine augmented with antipsychotics in treatment-resistant schizophrenia using standard outcome measures Health of Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16). METHOD: In a cross-sectional study of 83 patients on clozapine treated in a psychiatric rehabilitation hospital, the association between the primary outcome measure, LSP-16 including its subscales, and treatment with antipsychotic augmentation (AA) were analysed using linear regression. RESULT: The presence of moderate-to-severe positive symptoms on the HoNOS 6 dichotomised item measure was the only statistically significant predictor of functional impairment as determined by total LSP-16 score.The group of patients with ongoing positive symptoms (partial responders) were characterised by higher total LSP-16 scores, higher numbers of AA agents, and higher chlorpromazine equivalence. There was an inverse linear relationship between chlorpromazine equivalence of AA and total score of LSP-16 scale in the group of partial responders. CONCLUSION: Augmentation with other antipsychotic agents was associated with higher functioning in a cross-sectional study of patients with schizophrenia with poor response of positive symptoms to clozapine. This might be an important clinical factor to consider when prescribing antipsychotics to patients with clozapine-resistant schizophrenia.

Predictors of functioning and clinical outcomes in inpatient with schizophrenia on clozapine augmented with antipsychotics.

OBJECTIVE: We aimed at exploring predictors of improvement in clinical and functional outcomes of patients on clozapine with chronic treatment-resistant schizophrenia admitted into rehabilitation wards. METHOD: In a cross-sectional study of 62 patients on clozapine augmented with oral and parenteral antipsychotics, predictors of HoNOS (Health of the Nation Outcome Scales) scores were analysed using ordinal logistic regression. RESULT: Augmentation with parenteral antipsychotics was associated with lower psychotic symptom scores (OR 0.38 [95%CI 0.15, 0.99]) and activity of daily living scores (OR 0.36 [95%CI, 0.13, 0.96]) compared with oral antipsychotics. Increased age was a predictor of behavioural disturbances, physical illness and cognitive problems for all clozapine patients, and female gender was associated with the increase in depression scores. CONCLUSION: The addition of parental antipsychotics to clozapine in patients with treatment-resistant schizophrenia might have potential benefits for clinical and functional outcomes and needs a further investigation.