Optimizing clozapine through clinical decision making

Acta Psychiatrica Scandinavica

Volumn 126, Issue 1, 2012, Pages 47-58

  Falzer, P R ^a   Garman, D M ^b  

^a VA CONNECTICUT HEALTHCARE SYSTEM   (United States)

^b State of Connecticut   (United States)

Author keywords

Clozapine; Decision making; Education; Guidelines; Judgment; Schizophrenia

Indexed keywords

ARIPIPRAZOLE; CLOZAPINE; QUETIAPINE; RISPERIDONE; ZIPRASIDONE;

ADULT; ARTICLE; CLINICAL DECISION MAKING; CLINICAL PRACTICE; COMORBIDITY; COPING BEHAVIOR; FEMALE; HUMAN; LEARNING; MALE; PATIENT INFORMATION; POSITIVE AND NEGATIVE SYNDROME SCALE; PRACTICE GUIDELINE; PRIORITY JOURNAL; PSYCHIATRIST; PSYCHOPHARMACOTHERAPY; QUALITY OF LIFE; QUESTIONNAIRE; RESIDENT; SCHIZOPHRENIA; SCORING SYSTEM; SYMPTOM; TREATMENT RESPONSE;

ADULT; ANTIPSYCHOTIC AGENTS; CLOZAPINE; DECISION MAKING; FEMALE; GUIDELINE ADHERENCE; HUMANS; MALE; PSYCHIATRIC STATUS RATING SCALES; PSYCHIATRY; PSYCHOTIC DISORDERS; TREATMENT OUTCOME;

EID: 84862125530     PISSN: 0001690X     EISSN: 16000447     Source Type: Journal    
DOI: 10.1111/j.1600-0447.2012.01863.x     Document Type: Article

References (92)

1. Fayek M, Flowers C, Signorelli D, Simpson G. Psychopharmacology: underuse of evidence-based treatments in psychiatry. Psychiatr Serv 2003;54:1453-6.
2. Kane JM. PORT recommendations. Schizophr Bull 2004;30:605-7.
3. Kane J, Honigfeld G, Singer J, Meltzer H, and the Clozaril Collaborative Study Group. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789-96.
4. Conley RR, Tamminga CA, Kelly DL, Richardson CM. Treatment-resistant schizophrenic patients respond to clozapine after olanzapine non-response. Biol Psychiatry 1999;46:73-7.
5. McEvoy JP, Lieberman JA, Stroup TS et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006;163:600-10.
6. Lindstrom LH. A retrospective study on the long term efficacy of clozapine in 96 schizophrenic and schizoaffective patients during a 13 year period. Scientific Update Meeting: Clozapine (Leponex/Clozaril) (1988, Montreux, Switzerland). Psychopharmacology 1989;99:S84-S6.
7. Naber D, Leppig M, Grohmann R, Hippius H. Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia: a retrospective study of 387 patients. Scientific Update Meeting: Clozapine (Leponex/Clozaril) (1988, Montreux, Switzerland). Psychopharmacology 1989;99:S73-S6.
8. Tandon R, Wolfgang Fleischhacker W. Comparative efficacy of antipsychotics in the treatment of schizophrenia: a critical assessment. Schizophr Res 2005;79:145-55.
9. Wahlbeck K, Cheine M, Essali A, Adams C. Evidence of clozapine's effectiveness in schizophrenia: a systematic review and meta-analysis of randomized trials. Am J Psychiatry 1999;156:990-9.
10. Chakos M, Lieberman J, Hoffman E, Bradford D, Sheitman B. Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001;158:518-26.
11. Breier A, Buchanan RW, Kirkpatrick B et al. Effects of clozapine on positive and negative symptoms in outpatients with schizophrenia. Am J Psychiatry 1994;151:20-6.
12. Swartz MS, Stroup TS, McEvoy JP et al. What CATIE found: results from the schizophrenia trial. Psychiatr Serv 2008;59:500-6.
13. Kane JM, Saferman AZ, Pollack S et al. Clozapine, negative symptoms, and exrapyramidal side effects. J Clin Psychiatry 1994;55:74-7.
14. Lewis SW, Barnes TRE, Davies L et al. Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull 2006;32:715-23.
15. Goldberg TE, Weinberger DR. The effects of clozapine on neurocognition: an overview. J Clin Psychiatry 1994;55:88-90.
16. Swartz MS, Perkins DO, Stroup TS et al. Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study. Am J Psychiatry 2007;164:428-36.
17. Meltzer HY, Burnett S, Bastani B, Ramirez LF. Effects of six months of Clozapine treatment on the quality of life of chronic schizophrenic patients. Hosp Community Psychiatry 1990;41:892-7.
18. Honigfeld G, Patin J. A two-year clinical and economic follow-up of patients on clozapine. Hosp Community Psychiatry 1990;41:882-5.
19. Revicki DA, Luce BR, Weschler JM, Brown RE, Adler MA. Cost-effectiveness of clozapine for treatment-resistant schizophrenic patients. Hosp Community Psychiatry 1990;41:850-4.
20. Essock SM, Frisman LK, Covell NH, Hargreaves WA. Cost-effectiveness of clozapine compared with conventional antipsychotic medication for patients in state hospitals. Arch Gen Psychiatry 2000;57:987-94.
21. Basu A. Cost-effectiveness analysis of pharmacological treatments in schizophrenia: critical review of results and methodological issues. Schizophr Res 2004;71:445-62.
22. Moore TA, Buchanan RW, Buckley PF et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2006 update. J Clin Psychiatry 2007;68:1751-62.
23. Taylor DM, Young C, Paton C. Prior antipsychotic prescribing in patinets current receiving clozapine: a case note review. J Clin Psychiatry 2003;64:30-4.
24. Crilly J. The history of clozapine and its emergence in the US market: a review and analysis. Hist Psychiatry 2007;18:39-60.
25. Bastani B, Alphs LD, Meltzer HY. Development of the clozaril Patient Management System. Psychopharmacology 1989;99:S122-S5.
26. Hayhurst KP, Brown P, Lewis SW. Postcode prescribing for schizophrenia. Br J Psychiatry 2003;182:281-3.
27. Nielsen J, Dahm M, Lublin H, Taylor D. Psychiatrists' attitude towards and knowledge of clozapine treatment. J Psychopharmacol (Oxf) 2010;24:965-71.
28. Nielsen J, Damkier P, Lublin H, Taylor D. Optimizing clozapine treatment. Acta Psychiatr Scand 2011;123:411-22.
29. Kane JM. A user' guide to clozapine. Acta Psychiatr Scand 2011;123:407-8.
30. Hodge K, Jespersen S. Side-effects and treatment with clozapine: a comparison between the views of consumers and their clinicians. Int J Ment Health Nurs 2008;17:2-8.
31. Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 2004;22:3091-8.
32. Bogardus ST Jr, Bradley EH, Williams CS, Maciejewski PK, Van Doorn C, Inouye SK. Goals for the care of frail older adults: do caregivers and clinicians agree? Am J Med 2001;110:97-102.
33. Kon AA. The shared decision-making continuum. JAMA 2010;304:903-4.
34. Levander S, Eberhard J, Lindstrom E. Clinical decision-making during 5years of antipsychotic treatment. Acta Psychiatr Scand 2007;116:17-26.
35. Joosten EAG, Defuentes-Merillas L, De Weert GH, Sensky T, Van Der Staak CPF, De Jong CAJ. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008;77:219-26.
36. Fenton WS. Shared decision making: a model for the physician-patient relationship in the 21st century? [editorial]. Acta Psychiatr Scand 2003;107:401-2.
37. Hamann J, Cohen R, Leucht S, Busch R, Kissling W. Do patients with schizophrenia wish to be involved in decisions about their medical treatment? Am J Psychiatry 2005;162:2382-4.
38. Adams JR, Drake RE, Wolford GL. Shared decision-making preferences of people with severe mental illness. Psychiatr Serv 2007;58:1219-21.
39. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001.
40. Strauss J. Subjectivity and severe psychiatric disorders. Schizophr Bull 2011;37:8-13.
41. Kleinman A. Explanatory models in health-care relationships: a conceptual frame for research on family-based health-care activities in relation to folk and professional forms of clinical care. In: Stoeckle JD, ed. Encounters between patients and doctors: an anthology. Boston, MA: MIT Press, 1987: 273-86.
42. Teh CF, Karp JF, Kleinman A, Reynolds CF III, Weiner DK, Cleary PD. Older people's experiences of patient-centered treatment for chronic pain: a qualitative study. Pain Med 2009;10:521-30.
43. Agledahl KM, Førde R, Wifstad Å. Choice is not the issue. The misrepresentation of healthcare in bioethical discourse. J Med Ethics 2011;37:212-5.
44. Lomas J, Lavis J. Guidelines in the Mist. [Adobe Acrobat Document]: Centre for Health Economics and Policy Analysis Working Paper 96-23, December 1996; 1996 [updated 1996; cited 2009 September 11]; Available from: (cited by permission).
45. Weiner SJ. Contextualizing medical decisions to individualize care: lessons from the qualitative sciences. J Gen Intern Med 2004;19:281-5.
46. Weinmann S, Koesters M, Becker T. Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatr Scand 2007;115:420-33.
47. American Psychiatric Association. APA Practice Guideline Development Process (updated May 2006). [Adobe Acrobat document]: American Psychiatric Association; 2006 [updated 2006; cited 2009 October 15]; Available from:
48. Texas Department of State Health Services. Texas Implementation of Medical Algorithms. 2007 [updated 2007; cited October 15, 2009]; Available from:
49. Eddy DM. Evidence-based medicine: a unified approach. Health Aff (Millwood). 2005;24:9-17.
50. Maier T. Evidence-based psychiatry: understanding the limitations of a method. J Eval Clin Pract 2006;12:325-9.
51. Bilsker D, Goldner E. Teaching evidence-based practice: overcoming barriers. Brief Treat Crisis Interv 2004;4:271-5.
52. Weiner SJ, Schwartz A, Yudkowsky R et al. Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in medical decision making. Med Decis Making 2007;27:726-34.
53. Falzer PR, Garman DM. A conditional model of evidence based decision making. J Eval Clin Pract 2009;15:1142-52.
54. Falzer PR, Garman DM. Contextual decision making and the implementation of clinical guidelines: an example from mental health. Acad Med 2010;85:548-55.
55. Miller AL, Hall CS, Crismon ML, Chiles JA. TMA Procedural Manual: Schizophrenia Module. 2003 [updated 2003; cited March 1, 2006]; Available from:
56. Miller AL, Hall CS, Buchanan RW et al. The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry 2004;65:500-8.
57. Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale manual. North Tonawanda, NY: Multi-Health Systems, 1986. Contract No.: Document Number|.
58. Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008;28:1426-46.
59. Tarrier N, Sharpe L, Beckett R, Harwood R, Baker A, Yusopoff L. A trial of two cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: II. Treatment-specific changes in coping and problem-solving skills. Soc Psychiatry Psychiatr Epidemiol 1993;28:5-10.
60. Leventhal HL, Weinman J, Leventhal EA, Phillips LA. Health psychology: the search for pathways between behavior and health. Annu Rev Psychol 2008;59:477-505.
61. Cameron LD, Leventhal HL. The self-regulation of health and illness behavior. New York: Routledge, 2003.
62. Shah P, Hull T, Riley GA. Associations between the Illness Perception Questionnaire for Schizophrenia and engagement in treatment in a secure setting. Clin Psychol 2009;13:69-74.
63. Lobban F, Barrowclough C, Jones S. The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychol Med 2004;34:1165-76.
64. Hanley JA, Negassa A, Edwardes MDD, Forrester JE. Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol 2003;157:364-75.
65. Hardin JW, Hilbe JM. Generalized estimating equations. Boca Raton, FL: Chapman & Hall/CRC, 2003.
66. SPSS Inc. SPSS Advanced 18 for Windows. Chicago: SPSS Corporation, 2010.
67. Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff (Millwood) 2002;21:103-11.
68. Falzer PR, Garman DM. Evidence-based decision making as a practice-based learning skill: a pilot study. Acad Psychiatry 2012;36:104-109.
69. Epstein RM, Hundert EM. Defining and Assessing Professional Competence. JAMA 2002;287:226-35.
70. National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup. Bridging Science and Service. [World Wide Web document]: National Institute of Mental Health, 2002 [updated 2002; cited Aug. 16, 2002]; Available from:
71. New Freedom Commission on Mental Health. Achieving the promise: transforming mental health care in America. Final Report. DHHS Pub. No. SMA 03-3832. Rockville, MD; 2003 Contract No.: Document Number|.
72. Demakis JG, McQueen L, Kizer KW, Feussner JR. Quality Enhancement Research Initiative (QUERI): a collaboration between research and clinical practice. Med Care 2000;38:I-25.
73. Sung NS, Crowley WF Jr, Genel M et al. Central challenges facing the National Clinical Research Enterprise. JAMA 2003;289:1278-87.
74. Sheldon TA. Please bypass the PORT. Br Med J 1994;309:142-3.
75. Evidence-Based Medicine Working Group. Evidence-Based Medicine. A new approach to teaching the practice of medicine. Evidence-Based Medicine Working Group. JAMA 1992;268:2420-5.
76. Woolf SH. Practice guidelines: a new reality in medicine: I. Recent developments. Arch Intern Med 1990;150:1811-8.
77. Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82:581-629.
78. Mitton C, Adair CE, McKenzie E, Patten SB, Perry BW. Knowledge transfer and exchange: review and synthesis of the literature. Milbank Q 2007;85:729-68.
79. Drake RE, Goldman HH, Leff HS et al. Implementing evidence-based practices in routine mental health service settings. Psychiatr Serv 2001;52:179-82.
80. Fihn S. Moving implementation science forward. J Gen Intern Med 2006;21:S65-S6.
81. Proctor E, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health 2009;36:24-34.
82. Chambers D. Advancing the science of implementation: a workshop summary. Adm Policy Ment Health 2008;35:3-10.
83. Stahl SM, Buckley PF. Negative symptoms of schizophrenia: a problem that will not go away. Acta Psychiatr Scand 2007;115:4-11.
84. Kreyenbuhl J, Marcus SC, West JC, Wilk J, Olfson M. Adding or switching antipsychotic medications in treatment-refractory schizophrenia. Psychiatr Serv 2007;58:983-90.
85. Guaiana G, Tyson P, Roberts K, Mortimer A. Negative symptoms and not cognition predict social functioning among patients with schizophrenia. Schweiz Arch Neurol Psychiatr 2007;158:25-31.
86. Erhart SM, Marder SR, Carpenter WT. Treatment of schizophrenia negative symptoms: future prospects. Schizophr Bull 2006;32:234-7.
87. Arango C, Buchanan RW, Kirkpatrick B, Carpenter WT. The deficit syndrome in schizophrenia: implications for the treatment of negative symptoms. Eur Psychiatry 2004/1;19:21-6.
88. Crawford MJ, De Jonge E, Freeman GK, Weaver T. Providing continuity of care for people with severe mental illness: a narrative review. Soc Psychiatry Psychiatr Epidemiol 2004;39:265-72.
89. Safran D, Miller W, Beckman H. Organizational dimensions of relationship-centered care theory, evidence, and practice. J Gen Intern Med 2006;21:S9-S15.
90. Rapley T. Distributed decision making: the anatomy of decisions-in-action. Sociol Health Illn 2008;30:429-44.
91. Vella S-L, Pai N. A pharmacoepidemiological analysis of clozapine use in a region of Australia. Acta Psychiatr Scand 2011;124:413-4.
92. Nielsen J, Taylor D. Reply to a letter to the editor: a pharmacoepidemiological analysis of clozapine use in a region of Australia. Acta Psychiatr Scand 2011;124:414.