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LETTER TO EDITOR
Year : 2017  |  Volume : 39  |  Issue : 1  |  Page : 103-104  

Clozapine use in adolescents


Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication24-Jan-2017

Correspondence Address:
Samir Kumar Praharaj
Department of Psychiatry, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.198948

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How to cite this article:
Praharaj SK. Clozapine use in adolescents. Indian J Psychol Med 2017;39:103-4

How to cite this URL:
Praharaj SK. Clozapine use in adolescents. Indian J Psychol Med [serial online] 2017 [cited 2017 Sep 24];39:103-4. Available from: http://www.ijpm.info/text.asp?2017/39/1/103/198948

Sir,

I read with interest the study on metabolic disturbances, side effect profile and effectiveness of clozapine in adolescents by Grover et al.[1] in May–June issue of 2016. As the authors suggest clozapine is probably underused in adolescents, although it is not only found to be effective in early-onset treatment-resistant schizophrenia,[2],[3] but also in treatment-refractory mania,[4] autistic spectrum disorder,[5] severe conduct disorder,[6] and intermittent explosive disorder.[7]

There are indeed very few reports of safety and effectiveness of the use of clozapine in adolescent population from India. Although limited by small sample, the authors have followed up the cohort for more than 6 months and have systematically examined metabolic syndrome and its components. The prevalence and incidence rates of metabolic disturbances in adolescents exposed to clozapine are high in this study, which occurs more often in comparison to adults.[8]

The authors have reported results separately for complete data (n = 9) and imputed data (n = 13) using the last observation carried forward method. For all categorical data, repeated measures ANOVA and post hoc paired t-test were used. However, for categorical data, Pearson's Chi-square test or Fisher's exact test was used; both of these are tests of independence of proportions and are used when two independent groups are compared.[9],[10] Instead, for paired binary data, a Chi-square test for within group design, called McNemar's test is used, and for multiple paired binary data, Cochran's Q-test would be appropriate.[11],[12] It is suggested that in the current study, Cochran's Q-test may be used to compare proportions over three-time points, followed by post hoc McNemar's test.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Grover S, Hazari N, Chakrabarti S, Avasthi A. Metabolic disturbances, side effect profile and effectiveness of clozapine in adolescents. Indian J Psychol Med 2016;38:224-33.  Back to cited text no. 1
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2.
Schneider C, Corrigall R, Hayes D, Kyriakopoulos M, Frangou S. Systematic review of the efficacy and tolerability of clozapine in the treatment of youth with early onset schizophrenia. Eur Psychiatry 2014;29:1-10.  Back to cited text no. 2
    
3.
Schneider C, Papachristou E, Wimberley T, Gasse C, Dima D, MacCabe JH, et al. Clozapine use in childhood and adolescent schizophrenia: A nationwide population-based study. Eur Neuropsychopharmacol 2015;25:857-63.  Back to cited text no. 3
    
4.
Masi G, Mucci M, Millepiedi S. Clozapine in adolescent inpatients with acute mania. J Child Adolesc Psychopharmacol 2002;12:93-9.  Back to cited text no. 4
    
5.
Lambrey S, Falissard B, Martin-Barrero M, Bonnefoy C, Quilici G, Rosier A, et al. Effectiveness of clozapine for the treatment of aggression in an adolescent with autistic disorder. J Child Adolesc Psychopharmacol 2010;20:79-80.  Back to cited text no. 5
    
6.
Teixeira EH, Celeri EV, Jacintho AC, Dalgalarrondo P. Clozapine in severe conduct disorder. J Child Adolesc Psychopharmacol 2013;23:44-8.  Back to cited text no. 6
    
7.
Kant R, Chalansani R, Chengappa KN, Dieringer MF. The off-label use of clozapine in adolescents with bipolar disorder, intermittent explosive disorder, or posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2004;14:57-63.  Back to cited text no. 7
    
8.
Maayan L, Correll CU. Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol 2011;21:517-35.  Back to cited text no. 8
    
9.
Donner A, Petryshen P. The statistical analysis of matched data in psychiatric research. Psychiatry Res 1989;28:41-6.  Back to cited text no. 9
    
10.
Neely JG, Hartman JM, Forsen JW Jr., Wallace MS. Tutorials in clinical research: VII. Understanding comparative statistics (contrast) – Part B: Application of t-test, Mann–Whitney U, and Chi-square. Laryngoscope 2003;113:1719-25.  Back to cited text no. 10
    
11.
McHugh ML. The Chi-square test of independence. Biochem Med (Zagreb) 2013;23:143-9.  Back to cited text no. 11
    
12.
Agresti A. Categorical Data Analysis. New York: John Wiley & Sons; 2002.  Back to cited text no. 12
    




 

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