Effect of smoking habits and concomitant valproic acid use on relapse in patients with treatment-resistant schizophrenia receiving clozapine: A 1-year retrospective cohort study

No study has investigated the impact of smoking habits and concomitant valproic acid (VPA) use on clinical outcomes in maintenance treatment with clozapine. Thus, we aimed to examine the effect of smoking habits and concomitant VPA use on relapse during the first year after discharge in patients wit...

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Published in:Acta psychiatrica Scandinavica 2023-11, Vol.148 (5), p.437-446
Main Authors: Tsukahara, Masaru, So, Ryuhei, Yoshimura, Yusaku, Yamashita, Rieko, Yada, Yuji, Kodama, Masafumi, Nakajima, Shinichiro, Kishi, Yoshiki, Takeda, Toshihiko, Yamada, Norihito, Takeuchi, Hiroyoshi
Format: Article
Language:English
Subjects:
Antipsychotic Agents - therapeutic use
Antipsychotics
Blood levels
Clozapine
Clozapine - therapeutic use
Cohort analysis
Habits
Humans
Mental disorders
Patients
Retrospective Studies
Schizophrenia
Schizophrenia - drug therapy
Schizophrenia, Treatment-Resistant
Smoking
Smoking - epidemiology
Valproic acid
Valproic Acid - therapeutic use
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Summary:No study has investigated the impact of smoking habits and concomitant valproic acid (VPA) use on clinical outcomes in maintenance treatment with clozapine. Thus, we aimed to examine the effect of smoking habits and concomitant VPA use on relapse during the first year after discharge in patients with treatment-resistant schizophrenia (TRS) receiving clozapine. This retrospective cohort study included patients with TRS who were initiated on clozapine during hospitalization and discharged between April 2012 and January 2021 in two tertiary psychiatric hospitals in Japan. Relapse was defined as rehospitalization due to psychiatric exacerbation during the first year after discharge. A multivariable Cox proportional hazards regression analysis was performed to analyze the effect of smoking habits and concomitant VPA use on relapse. Subgroup analyses were also conducted to examine potential interactions between smoking habits and concomitant VPA use. Among the included 192 patients, 69 (35.9%) met the criteria of relapse. While smoking habits (adjusted hazard ratio [aHR], 2.27; 95% confidence interval [CI], 1.28-4.01; p 
ISSN:0001-690X
1600-0447
1600-0447
DOI:10.1111/acps.13612