Effect of a hospital-based multidisciplinary outreach service on readmission prevention for first-episode schizophrenia: A propensity score-matched cohort study.

Multidisciplinary outreach services are promising approaches in preventing relapse of people with first-episode schizophrenia. Previous studies have evaluated the effect of multidisciplinary outreach services on readmission prevention, but results were inconsistent. Therefore, we conducted a single-centre, retrospective, propensity score-matched cohort study to determine whether multidisciplinary outreach services for people with first-episode schizophrenia effectively prevent readmission in Japanese real-world settings. We adjusted potential confounding factors prospectively collected for another study. The primary outcome measure was days until readmission. We used data from 124 people with first-episode schizophrenia for matching and included 86 matched patients in the analyses; 43 patients with multidisciplinary outreach services and 43 without. The result showed that the percentage of patients not readmitted with and without multidisciplinary outreach services were 77% and 72% at 6 months, 63% and 67% at 12 months, and 53% and 67% at 18 months. Although not statistically significant, the risk of compulsory readmission was less in the group with multidisciplinary outreach services than in the group without. In conclusion, we failed to demonstrate that our hospital-based multidisciplinary outreach service had a significant effect on first-episode schizophrenia patients following their first hospitalisation. Improved treatment adherence in the group with multidisciplinary outreach services could be a reason for our insignificant readmission results. Larger real-world studies with detailed confounding data would be needed to confirm our results.

Hypotension induced by the concomitant use of a calcium-channel blocker and clarithromycin.

In the elderly, calcium-channel blockers are the first-line treatment for hypertension, and macrolides are commonly prescribed antibiotics. Here we report a 78-year-old man taking nifedipine, diltiazem and carvedilol who presented with persistent hypotension and bradycardia after clarithromycin was prescribed. He was diagnosed with drug-induced hypotension and treated with fluid resuscitation and vasoactive agents. His symptoms gradually improved. He was transferred out of the intensive care unit 3 days after hospitalisation. Combining calcium-channel blockers and clarithromycin can cause vasodilatory hypotension. The concomitant use of calcium-channel blockers and macrolide antibiotics increases the levels of calcium-channel blockers in the blood as they are metabolised by cytochrome P450 3A4 (CYP3A4), which is inhibited by macrolide antibiotics. Moreover, the addition of another calcium-channel blocker and a ß blocker can lower cardiac output due to bradycardia and worsen hypotension. Therefore, it is important to consider drug interactions when the cause of hypotension is unknown.