1 Mental Health Centre Glostrup, Mental Health Services, University of Copenhagen, Glostrup, Denmark.
2 Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark.
J Psychopharmacol. 2018 Nov;32(11):1197-1203. doi: 10.1177/0269881118783322. Epub 2018 Jun 26.
Comorbid mental illness is common in patients with intellectual disability. Antipsychotics are widely used for these conditions, but the effect of clozapine remains largely unknown.
We aimed to investigate the effectiveness of clozapine on naturalistic outcomes in patients with intellectual disability.
By combining the national health registers, we identified all patients in Denmark with intellectual disability initiating clozapine treatment during the period 1996-2012. We used a mirror-image model to test whether initiation of clozapine treatment was associated with reduction in psychiatric admissions and inpatient days, reduction in the number of individuals performing intentional self-harm or overdose, and less frequent use of concomitant psychopharmacological treatment. Similar outcome measures were used in a reverse mirror-image model to investigate the effects of clozapine termination.
A total of 405 patients with intellectual disability redeemed clozapine. After initiation of clozapine the number of psychiatric admissions were reduced by 0.65 admissions (95% CI: 0.31-1.00) and the inpatient days were reduced by 67.2 days (95% CI: 51.2-83.3), with a similar decrease for patients with intellectual disability without psychiatric comorbidity. Clozapine treatment was not found to reduce the number of individuals with intentional self-harm, incidents of overdose, or the use of concomitant psychotropics. In cases where clozapine treatment was terminated, the number of psychiatric admissions increased by 0.57 admissions (95% CI: 0.01-1.12).
This nationwide study, which is the largest to date, suggests that treatment with clozapine is associated with a reduction in psychiatric admissions and inpatient days in patients with intellectual disability. Further studies evaluating the effects of clozapine in patients with intellectual disability are warranted.
合并精神疾病在智力障碍患者中很常见。抗精神病药物被广泛用于这些疾病，但氯氮平的疗效在很大程度上仍不清楚。
我们旨在研究氯氮平对智力障碍患者自然转归的疗效。
通过结合国家健康登记，我们确定了所有在丹麦于 1996-2012 年期间开始氯氮平治疗的智力障碍患者。我们使用镜像模型来检验氯氮平治疗的起始是否与减少精神科住院和住院天数、减少故意自我伤害或药物过量人数以及减少同时使用精神药理学治疗有关。在反向镜像模型中，我们使用了类似的转归措施来研究氯氮平停药的影响。
共有 405 例智力障碍患者使用了氯氮平。开始氯氮平治疗后，精神科住院人数减少了 0.65 人次（95%可信区间：0.31-1.00），住院天数减少了 67.2 天（95%可信区间：51.2-83.3），而无精神共病的智力障碍患者也有类似的减少。氯氮平治疗并未发现减少故意自我伤害、药物过量的人数或同时使用精神药物的人数。在氯氮平治疗终止的情况下，精神科住院人数增加了 0.57 人次（95%可信区间：0.01-1.12）。
这项目前为止最大规模的全国性研究表明，氯氮平治疗与智力障碍患者的精神科住院人数和住院天数减少有关。需要进一步研究评估氯氮平在智力障碍患者中的疗效。
