Focussing on the fundaments - assessing and treating Clozapine Induced Gastrointestinal Hypomotility.

Background: Clozapine is a second-generation antipsychotic used in treatment-resistant Schizophrenia (TRS). Clozapine Induced Gastrointestinal Hypomotility (CIGH) is the commonest cause of clozapine related death, yet remains under-recognised and under-monitored.Aims and hypothesis: To review the pharmacological management of CIGH. We hypothesised that pharmacological interventions would reduce the incidence of adverse outcomes associated with CIGH.Methods: We retrospectively reviewed consecutive patients treated on clozapine over a one year period on a male acute psychiatric ward. Information on patient demographics, CIGH symptomatology, treatment and outcome were extracted.Results: In total, 14 male patients with a mean age of 43 years (standard deviation 10 years) were included. Of these, 9 patients experienced CIGH during admission, in all cases presenting as constipation. Among patients experiencing CIGH, 8 of 9 (89%) patients received one or more interventions. This was most commonly a stimulant, or osmotic laxative. By discharge, the 8 patients treated were in full remission of CIGH symptoms.Conclusions: A high proportion of patients treated with clozapine experience CIGH, presenting most commonly as constipation. Whilst potentially life-threatening, CIGH can be successfully treated in an acute inpatient setting. Active monitoring of CIGH symptoms in patients initiated, or reinitiated on clozapine is recommended.Key pointsA high proportion of patients treated with Clozapine experience constipation, the cardinal feature of Clozapine Induced Gastrointestinal Hypomotility.Whilst potentially life-threatening, CIGH can be successfully treated in an acute inpatient setting with simple interventions.Active monitoring of CIGH symptoms in patients initiated, or reinitiated on clozapine is recommended.Future research on the potential benefit of prophylactic intervention would be beneficial.

Clinical and demographic differences between patients with manic, depressive and schizophrenia-spectrum psychoses presenting to Early Intervention Services in London.

AIM: To investigate the relationship between the presenting clinical and demographic characteristics in first-episode psychosis (FEP) patients with their clinical diagnostic grouping 1 year later. METHODS: Data from 1014 first-presentation psychosis patients from seven London-based Early Intervention Services were extracted from the MiData audit database. Associations between clinical and demographic measures at presentation and clinical diagnosis made at 1 year were assessed with analysis of variance (ANOVA) and Chi-square tests. RESULTS: The sample comprised 76% of patients with schizophrenia-spectrum diagnoses, 9% with manic psychoses (MP) and 6% with depressive psychoses. Compared to the other 2 groups, patients who were diagnosed as having MP were younger, with higher education and shorter duration of untreated psychosis, and had higher Young Mania Rating Scale scores at presentation and lower Positive and Negative Syndrome Scale (PANSS) negative scores. Patients diagnosed at 1 year as having depressive psychosis were older and more likely to be white, with the lowest PANSS positive scores at baseline. Patients diagnosed at 1 year as having schizophrenia spectrum diagnoses were more likely to be males. Patients in the 3 diagnostic subgroups of psychosis differed on both clinical and demographic characteristics at presentation. CONCLUSIONS: There were significant clinical and demographic differences at presentation between FEP patients who received different clinical diagnoses at 1 year. Future work should determine the extent to which these differences can be used to guide clinical care.