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Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia.

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Title: Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia.
Authors: McCutcheon, R., Beck, K., D'Ambrosio, E., Donocik, J., Gobjila, C., Jauhar, S., Kaar, S., Pillinger, T., Reis Marques, T., Rogdaki, M., Howes, O. D.
Source: Acta Psychiatrica Scandinavica. Jan2018, Vol. 137 Issue 1, p39-46. 8p.
Subjects: Schizophrenia treatment, Drug interactions, Clozapine, Physiological effects of antipsychotic drugs, Pharmacokinetics
Abstract: Objective Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. Method Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine. Patients were followed up to determine whether they were subsequently admitted to hospital. Results Thirty-five per cent of plasma levels were subtherapeutic, and of these, 34% were undetectable. Black ethnicity ( P = 0.006) and lower dose ( P < 0.001) were significantly associated with subtherapeutic/undetectable plasma levels. Individuals with subtherapeutic/undetectable levels were significantly more likely to be admitted to hospital ( P = 0.02). Conclusion A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The presence of subtherapeutic plasma levels may suggest a need to address adherence or pharmacokinetic factors as opposed to commencing clozapine treatment. While antipsychotic levels are not recommended for the routine adjustment of dosing, they may assist with the assessment of potential treatment resistance in schizophrenia. [ABSTRACT FROM AUTHOR]
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22McCutcheon%2C+R%2E%22&quot;&gt;McCutcheon, R.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Beck%2C+K%2E%22&quot;&gt;Beck, K.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22D&#39;Ambrosio%2C+E%2E%22&quot;&gt;D&#39;Ambrosio, E.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Donocik%2C+J%2E%22&quot;&gt;Donocik, J.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gobjila%2C+C%2E%22&quot;&gt;Gobjila, C.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jauhar%2C+S%2E%22&quot;&gt;Jauhar, S.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kaar%2C+S%2E%22&quot;&gt;Kaar, S.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pillinger%2C+T%2E%22&quot;&gt;Pillinger, T.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Reis+Marques%2C+T%2E%22&quot;&gt;Reis Marques, T.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rogdaki%2C+M%2E%22&quot;&gt;Rogdaki, M.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Howes%2C+O%2E+D%2E%22&quot;&gt;Howes, O. D.&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Acta+Psychiatrica+Scandinavica%22&quot;&gt;Acta Psychiatrica Scandinavica&lt;/searchLink&gt;. Jan2018, Vol. 137 Issue 1, p39-46. 8p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Schizophrenia+treatment%22&quot;&gt;Schizophrenia treatment&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Drug+interactions%22&quot;&gt;Drug interactions&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Clozapine%22&quot;&gt;Clozapine&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Physiological+effects+of+antipsychotic+drugs%22&quot;&gt;Physiological effects of antipsychotic drugs&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Pharmacokinetics%22&quot;&gt;Pharmacokinetics&lt;/searchLink&gt;
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  Data: Objective Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. Method Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine. Patients were followed up to determine whether they were subsequently admitted to hospital. Results Thirty-five per cent of plasma levels were subtherapeutic, and of these, 34% were undetectable. Black ethnicity ( P = 0.006) and lower dose ( P &lt; 0.001) were significantly associated with subtherapeutic/undetectable plasma levels. Individuals with subtherapeutic/undetectable levels were significantly more likely to be admitted to hospital ( P = 0.02). Conclusion A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The presence of subtherapeutic plasma levels may suggest a need to address adherence or pharmacokinetic factors as opposed to commencing clozapine treatment. While antipsychotic levels are not recommended for the routine adjustment of dosing, they may assist with the assessment of potential treatment resistance in schizophrenia. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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