The practical management of refractory schizophrenia: the Maudsley Treatment REview and Assessment Team service approach

TY - JOUR

T1 - The practical management of refractory schizophrenia

T2 - the Maudsley Treatment REview and Assessment Team service approach

AU - Beck, K.

AU - Mccutcheon, R.

AU - Bloomfield, M. A P

AU - Gaughran, F.

AU - Reis Marques, T.

AU - Maccabe, J.

AU - Selvaraj, S.

AU - Taylor, David

AU - Howes, Oliver D.

PY - 2014/12

Y1 - 2014/12

N2 - Objective: To describe a practical approach to the community management of treatment-resistant schizophrenia (TRS). Method: A descriptive review of an approach to the assessment and management of patients with TRS, including the community titration of clozapine treatment, and a report of the management recommendations for the first one hundred patients assessed by the Treatment REview and Assessment Team (TREAT). Results: The standardized model for the community assessment, management and titration of clozapine is described. To date, 137 patients have been referred to this service and 100 patients (72%) attended for assessment. Of these, 33 have been initiated on clozapine while fifteen have had clozapine recommended but have not wished to undertake clozapine treatment. Other management options recommended have included augmentation strategies and long-acting injectable antipsychotics. Conclusion: The service had increased the number of patients receiving community assessment and initiation of clozapine by five-fold relative to the rate prior to the establishment of the service. The large number of referrals and high attendance rate indicates that there is clinical demand for the model. Systematic evaluation is required to determine the clinical and cost-effectiveness of this model and its potential application to other clinical settings.

AB - Objective: To describe a practical approach to the community management of treatment-resistant schizophrenia (TRS). Method: A descriptive review of an approach to the assessment and management of patients with TRS, including the community titration of clozapine treatment, and a report of the management recommendations for the first one hundred patients assessed by the Treatment REview and Assessment Team (TREAT). Results: The standardized model for the community assessment, management and titration of clozapine is described. To date, 137 patients have been referred to this service and 100 patients (72%) attended for assessment. Of these, 33 have been initiated on clozapine while fifteen have had clozapine recommended but have not wished to undertake clozapine treatment. Other management options recommended have included augmentation strategies and long-acting injectable antipsychotics. Conclusion: The service had increased the number of patients receiving community assessment and initiation of clozapine by five-fold relative to the rate prior to the establishment of the service. The large number of referrals and high attendance rate indicates that there is clinical demand for the model. Systematic evaluation is required to determine the clinical and cost-effectiveness of this model and its potential application to other clinical settings.

KW - Antipsychotics

KW - Clozapine

KW - Community

KW - Health service

KW - Schizophrenia

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=84909961040&partnerID=8YFLogxK

U2 - 10.1111/acps.12327

DO - 10.1111/acps.12327

M3 - Article

AN - SCOPUS:84909961040

SN - 0001-690X

VL - 130

SP - 427

EP - 438

JO - Acta Psychiatrica Scandinavica

JF - Acta Psychiatrica Scandinavica

IS - 6

ER -