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Research ArticleRegular Articles

Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population

Theodore R. Zarzar, James P. Mayo, David L. Rosen, Joseph B. Williams, Terri L. Catlett, Maria G. O'Connell, Genell N. Rashad, John G. Reed, Carrie L. Brown, Brian V. Robbins, Herman A. Naftel and Brian B. Sheitman
Journal of the American Academy of Psychiatry and the Law Online December 2021, 49 (4) 581-589; DOI: https://doi.org/10.29158/JAAPL.210011-21
Theodore R. Zarzar
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
MD
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James P. Mayo III
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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David L. Rosen
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
PhD, MD
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Joseph B. Williams
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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Terri L. Catlett
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
PA
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Maria G. O'Connell
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
MD
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Genell N. Rashad
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
MA
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John G. Reed
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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Carrie L. Brown
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
MD, MPH
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Brian V. Robbins
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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Herman A. Naftel
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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Brian B. Sheitman
Dr. Zarzar is Clinical Associate Professor, Dr. Mayo is Fellow in Child and Adolescent Psychiatry, Dr. Williams is Clinical Associate Professor, Dr. Brown is Clinical Associate Professor, Dr. Robbins is Clinical Professor, and Dr. Naftel is Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Rosen is Research Associate Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Director of Healthcare Administration, Dr. O'Connell is Director of Mental Health, Central Prison Healthcare Complex, Ms. Rashad is Staff Psychologist, Mr. Reed is Clinical Pharmacist, and Dr. Sheitman is Chief of Psychiatry, North Carolina Department of Public Safety - Prisons, Raleigh, NC.
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    Figure 1.

    Distributions of the difference in assigned restrictive housing (RH) days among patients before (pre) and after (post) clozapine treatment for 0–3, 3–6, 6–9, and 9–12 months. The X indicates the mean reduction; the shaded area represents the interquartile range, and whiskers represent minimum and maximum values excluding outliers (i.e., values > 1.5 times the interquartile range below the 25th percentile or above the 75th percentile; outliers not shown). Median values are typically represented by a horizontal line within the interquartile range, but in these plots, the median overlaps with the 75th percentile line (i.e., has a value of zero).*The test to detect a pre-/post difference was statistically significant using the Wilcoxon-Signed Rank Test (P < 0.05).

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    Figure 2.

    Distribution of quarterly assigned restrictive housing (RH) days among patients during 12 months of continuous clozapine treatment The X indicates the mean reduction; the shaded area represents the interquartile range, and whiskers represent minimum and maximum values excluding outliers (i.e., values > 1.5 times the interquartile range below the 25th percentile or above the 75th percentile; outliers not shown). Median values are typically represented by a horizontal line within the interquartile range, but in some instances the median overlaps with the 25th percentile line (i.e., has a value of zero).

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    Table 1

    Demographic and Clinical Characteristics of Patients Receiving Clozapine for ≥ 3 Months or < 3 Months

    CharacteristicsClozapine ≥ 3 MonthsClozapine < 3 MonthsP
    Subjects, n5925
    Sex1.0
        Male49 (83.1)21 (84.0)
        Female10 (16.9)4 (16.0)
    Race0.24
        White32 (54.2)9 (36.0)
        Black21 (35.6)14 (56.0)
        Other6 (10.2)2 (8.0)
    Age, years0.27
        18–257 (11.9)3 (12.0)
        26–4038 (64.4)12 (48.0)
        > 4014 (23.7)10 (40.0)
    Gang affiliation19 (32.2)6 (10.2)0.60
    Primary psychiatric diagnosis0.34
        Psychotic disorder23 (39.0)13 (52.0)
        Personality disorder36 (61.0)12 (48.0)
    History of self-injurious behavior or suicide attempt57 (96.6)19 (76.0)0.008
    Substance use disorder57 (96.6)21 (84.0)0.06
    Prior medication trials in prison
        Antipsychotic3.8 ± 2.03.4 ± 2.2
        Mood stabilizer1.8 ± 1.11.2 ± 1.2
    Intellectual disability3 (5.1)2 (8.0)0.63
    Seizure disorder12 (20.3)2 (8.0)0.21
    • Data are presented as n (%) or mean ± SD.

    • View popup
    Table 2

    Distribution of Assigned Restrictive Housing Days Pre- and Post- Clozapine Treatment

    Duration of Clozapine Treatment
    0–3 Months3–6 Months6–9 Months9–12 Months
    Pre-Post-DifferencePre-Post-DifferencePre-Post-DifferencePre-Post-Difference
    Maximum8558703001,19524070585105401,09012080
    75% percentile700052.5007500112.5100
    Median0000000001000
    25% percentile00−6000−52.500−6000−97.5
    Minimum00−36000−1,19500−51000−1,000
    P*.0005.0013.0006.01
    Subjects, n59443324
    • ↵* Determined with the Wilcoxon signed rank test.

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Journal of the American Academy of Psychiatry and the Law Online: 49 (4)
Journal of the American Academy of Psychiatry and the Law Online
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1 Dec 2021
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Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population
Theodore R. Zarzar, James P. Mayo, David L. Rosen, Joseph B. Williams, Terri L. Catlett, Maria G. O'Connell, Genell N. Rashad, John G. Reed, Carrie L. Brown, Brian V. Robbins, Herman A. Naftel, Brian B. Sheitman
Journal of the American Academy of Psychiatry and the Law Online Dec 2021, 49 (4) 581-589; DOI: 10.29158/JAAPL.210011-21

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Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population
Theodore R. Zarzar, James P. Mayo, David L. Rosen, Joseph B. Williams, Terri L. Catlett, Maria G. O'Connell, Genell N. Rashad, John G. Reed, Carrie L. Brown, Brian V. Robbins, Herman A. Naftel, Brian B. Sheitman
Journal of the American Academy of Psychiatry and the Law Online Dec 2021, 49 (4) 581-589; DOI: 10.29158/JAAPL.210011-21
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Keywords

  • restrictive housing
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