title: Use of clozapine in a state child and adolescent psychiatric hospital.
abstract: We assessed the predictors of clozapine initiation among youth 18 years and younger within a state psychiatric hospital. Administrative data (n = 358) were evaluated of inpatients from a long-term state child and adolescent psychiatric hospital. We investigated 25 background and clinical patient characteristics to determine which factors predicted clozapine initiation following the first 21 days of hospital admission. A Cox proportional model was used to evaluate factors that independently predicted the hazard rate of clozapine initiation. Emergency medication administration during the first 3 weeks of admission, which was more common among the clozapine (84.9 %) than control (61.7 %) patients (p < 0.001), was associated with a significantly increased probability of clozapine initiation (Hazard Ratio = 1.9, 95 % Confidence Interval = 1.2-3.1). Use of a mood stabilizer during the first 3 weeks of the inpatient was non-significantly related to an increased probability of clozapine initiation (Hazard Ratio = 1.7, 95 % Confidence Interval = 1.0-2.9). In this setting, emergency medication use predicts clozapine initiation suggesting that it may be used to treat patients with aggressive behavior.
authors.affiliation: New York City Children's Center, New York State Office of Mental Health, Brooklyn, NY, USA. vanessa.bobb@omh.ny.gov
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bobb
authors.forename: Michael
authors.initials: M
authors.lastname: Weinberg
authors.forename: Stewart
authors.initials: S
authors.lastname: Gabel
authors.forename: Harvey
authors.initials: H
authors.lastname: Kranzler
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003024:Clozapine / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine