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

Acta Psychiatrica Scandinavica
Robert McCutcheonOliver D Howes

Abstract

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. 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. 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). A significant proportion of patients considered treatment-resistant have subtherapeutic antipsychotic plasma levels, and this is associated with subsequent admission. The prese...Continue Reading

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Citations

Nov 27, 2018·Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists·Peter McInnis, John Kasinathan
Nov 28, 2018·Irish Journal of Psychological Medicine·J Lally, F Gaughran
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