Augmenting clozapine with sertindole: a double-blind, randomized, placebo-controlled study.

Clozapine augmentation with antipsychotic drugs is widely used despite sparse evidence supporting this strategy. Sertindole is a nonsedating atypical antipsychotic drug with low affinity for cholinergic receptors, which makes it potentially suitable for augmentation of clozapine. The study design was a 12-week, double-blind, randomized, placebo-controlled study including patients with International Statistical Classification of Diseases, 10th Revision schizophrenia (F20.0-F20.3) and treated with clozapine for at least 6 months who had not achieved sufficient response. Patients were randomized 1:1 to either sertindole 16 mg or placebo, and assessment was done at baseline and after 6 and 12 weeks. Assessment included the Positive and Negative Syndrome Scale, Clinical Global Impression, Udvalg for Kliniske Undersøgelser, World Health Organization Quality of Life Brief, Drug Attitude Inventory, fasting glucose, lipids, and electrocardiogram. Clozapine augmentation with sertindole was not superior to placebo regarding total score or subscale score of the Positive and Negative Syndrome Scale, Clinical Global Impression, World Health Organization Quality of Life Brief, or Drug Attitude Inventory. No increased adverse effects compared with placebo were found. Four patients randomized to sertindole experienced a significant worsening of psychosis, and 2 of them required psychiatric admission. Metabolic parameters were unchanged during the study, but augmentation of clozapine with sertindole was associated with a 12-millisecond (SD, 20-millisecond) QTc prolongation compared with 0 millisecond (SD, 20 milliseconds) in the placebo group (P < 0.03). Augmentation with sertindole showed no benefits compared with placebo. Psychiatrists should be aware that augmentation might not add any benefits for the patients and in some cases worsen psychosis.

Non-compliance in community psychiatry: failed appointments in the referral system to psychiatric outpatient treatment.

Knowledge about the drop-out pattern of psychiatric patients in the referral phase for outpatient treatment is limited. The aim of the present study was to investigate the importance of selected psychiatric, demographic and administrative parameters in this matter. In a newly opened community psychiatric unit with an open referral system, available relevant data concerning the referred patients were gathered over a 6-month period. Of the 137 patients included in the study, 32% did not show up for their first appointment. On making further attempts to contact the patients, the drop-out frequency dropped to 16%, demonstrating that it is worthwhile offering new appointments to the patients who do not show up. There was no demonstrable relation between the time the patients had waited for the first appointment with a psychiatrist and the drop-out frequency. For patients who had been referred with a diagnosis of psychosis (F 20-29, WHO criteria), or addiction, or had been previously admitted to psychiatric hospital, there was a significant increase in the drop-out rate.