Original Research Article
Year: 2019 | Month: October-December | Volume: 4 | Issue: 4 | Pages: 11-18
Side-Effect Profile and Illness Related Disability among Patients on Maintenance Treatment with Clozapine
Dr. Joylin Jovita Mascarenhas1, Dr. Abhijith Krishna2
1Associate Professor, Department of Psychiatry, Father Muller Medical College, Mangalore.
2Former Senior Resident, Father Muller Medical College and Current Senior Registrar, North-western Mental Health Services, Melbourne.
Corresponding Author: Dr. Joylin Jovita Mascarenhas
ABSTRACT
Background: Clozapine is considered the gold standard for management of treatment-resistant Schizophrenia. It is also beneficial for psychiatric illnesses associated with severe extra pyramidal side effects. It improves the psychopathology and functional outcome in patients with severe mental illness. The long-term effects of clozapine with respect to its side effect profile and illness related disability has not been studied among Indian population.
Aims: (i) To assess the long term side effects of clozapine (ii)To assess the relationship between psychiatric disorder and side effect profile (iii)To assess the level of disability due to the illness (iv) To find out if the disability is associated with duration of illness(DUI) and type of illness.
Methodology: Thirty five patients fulfilling the inclusion criteria and attending the Clozapine clinic from September 1st to 30th 2015 were recruited. The Glasgow Anti-psychotic Side effect Scale for Clozapine (GASS-C) was administered to assess the side effects of clozapine and the Indian Disability Evaluation Assessment Scale (IDEAS) to determine disability. The results were analysed using SPSS.
Results: The most common side effects of clozapine were drowsiness/sedation and hypersalivation (48.57%), followed by constipation and elevated sugars (17.14%), gastrointestinal side effects (14.29%), postural hypotension (11.42%), tachycardia and myoclonus/seizures (8.57%), anticholinergic side effects, nocturnal enuresis, weight gain and eosinophilia (5.71%). Erectile dysfunction, mild leucopenia, elevated blood pressure and lipid profile (2.86%) were the least common side-effects.11.42% reported that the side effects were severe or distressing. Patients with DUI of 6-10years and more than 10years had mild (45.71%) to moderate disability(42.86%), irrespective of the type of the psychiatric disorder. However 11.42% of patients with DUI >10years, with a diagnosis of treatment resistant schizophrenia continued to have severe disability. There was no statistically significant difference between the DUI and psychiatric disorder patients with respect to disability.
Conclusion: The long term side effects have to be assessed and appropriate treatment initiated to improve the quality of life and ensure treatment compliance. Suitable psychosocial intervention and therapies are required to reduce disability in psychosocial role functioning along with pharmacological intervention in these patients.
Key words: Clozapine, Long-term Side-effects, Disability