PDF(Pubmed)
Abstract：
BACKGROUND: Clozapine is an off-label drug used in most countries to prevent suicide in individuals with schizophrenia. However, few studies have reported real-world prescription practices. This study aimed to explore the association between a history of suicidal behavior and clozapine prescribing during eight weeks of hospitalization for individuals with early-stage schizophrenia.
METHODS: This observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates.
RESULTS: The prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08-17.83]) or during hospitalization (4.18[1.62-10.78]).
CONCLUSIONS: The use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.
METHODS: This observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates.
RESULTS: The prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08-17.83]) or during hospitalization (4.18[1.62-10.78]).
CONCLUSIONS: The use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.
摘要：
背景：氯氮平是一种在大多数国家用于预防精神分裂症患者自杀的标签外药物。然而,很少有研究报告真实世界的处方实践。这项研究旨在探讨早期精神分裂症患者住院八周期间自杀行为史与氯氮平处方之间的关系。
方法：这项观察性队列研究使用了从北京一家精神病医院收集的常规健康数据，中国。该研究包括1057名在3年内有精神分裂症发作的住院患者。根据哥伦比亚自杀严重程度等级量表，通过审查医疗记录对自杀行为的病史进行编码。从处方记录中提取了住院期间使用抗精神病药的信息。使用经社会人口统计学和临床协变量校正的Cox回归模型分析使用氯氮平的时间。
结果：自我伤害的患病率，自杀行为,自杀企图是12.3%,7.5%,和5.4%，分别。自我伤害史与入院时使用氯氮平呈正相关(4.1%vs.0.8%,精确p=0.009)。在那些没有使用氯氮平和没有氯氮平禁忌症的人中，自杀行为史增加了入院后56天内改用氯氮平的可能性(危险比[95%CI],6.09[2.08-17.83]）或住院期间（4.18[1.62-10.78]）。
结论：在中国有自杀行为者中，使用氯氮平治疗早期精神分裂症的频率高于无自杀行为者，尽管药物说明书没有标注其用于自杀风险。
方法：这项观察性队列研究使用了从北京一家精神病医院收集的常规健康数据，中国。该研究包括1057名在3年内有精神分裂症发作的住院患者。根据哥伦比亚自杀严重程度等级量表，通过审查医疗记录对自杀行为的病史进行编码。从处方记录中提取了住院期间使用抗精神病药的信息。使用经社会人口统计学和临床协变量校正的Cox回归模型分析使用氯氮平的时间。
结果：自我伤害的患病率，自杀行为,自杀企图是12.3%,7.5%,和5.4%，分别。自我伤害史与入院时使用氯氮平呈正相关(4.1%vs.0.8%,精确p=0.009)。在那些没有使用氯氮平和没有氯氮平禁忌症的人中，自杀行为史增加了入院后56天内改用氯氮平的可能性(危险比[95%CI],6.09[2.08-17.83]）或住院期间（4.18[1.62-10.78]）。
结论：在中国有自杀行为者中，使用氯氮平治疗早期精神分裂症的频率高于无自杀行为者，尽管药物说明书没有标注其用于自杀风险。
