RESUMEN
BACKGROUND: Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings. AIMS: To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts. METHOD: Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics. RESULTS: In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83-0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49-0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18-1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively. CONCLUSIONS: Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.
RESUMEN
Objective: To develop a scale for emotional regulation using item response theory. Method: Eighteen Swanson Nolan and Pelham (SNAP-IV) items that loaded on an emotional dysregulation factor were submitted to Rasch analysis. After eliminating the items that violated Rasch criteria, the remaining items were examined for reliability and validated against the Conners' emotional lability index. Results: A nine-item scale for emotional regulation was developed that satisfies the Rasch model and reliably distinguishes emotionally dysregulated/irritable children and adolescents. A score of 4 or higher in this scale has optimal accuracy for identifying children and adolescents with current significant dysfunction in emotional regulation. Among youth with ADHD inattentive, hyperactive-impulsive, and combined types, 42%, 56%, and 71% met the Clinical Evaluation of Emotional Regulation-9 (CEER-9) threshold for emotional lability, respectively. Conclusion: A nine-item scale whose sum total is a measure of emotional regulation is proposed as a tool for clinical and research purposes.