New blood tests for patients with schizophrenia with quick results

11 August 2021

A new, easy-to-use blood testing solution monitoring treatment for patients with schizophrenia reduces result waiting time from days to minutes. This innovative solution improves transparency, patients’ experiences and has the potential to be used in other health contexts.

Prof Mitul Mehta, Professor of Neuroimaging & Psychopharmacology at King’s College London, Deputy Lead for the Maudsley National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Mental Health, and Director of the Centre for Innovative Therapeutics, [pictured right], describes the recent research into a ground-breaking new blood test that improves healthcare treatment for people with schizophrenia.

Schizophrenia is a severe mental disorder that affects 20 million people across the globe. This chronic disorder is characterised by distortions in thinking, perception, emotions, language, sense of self and behaviour, and can be very difficult to treat. The condition often has a significant impact on patients’ lives and the NHS, as it requires regular engagement with NHS services during acute and recovery episodes.

Treatment resistance and health risks associated with some medications

The primary treatments for schizophrenia are antipsychotic drugs. Some patients respond well to antipsychotic medication, and some do not. Patients who do not respond well to these antipsychotic drugs are “treatment resistant” and this can be due to many different causes and factors.

When patients are “treatment resistant” to antipsychotic drugs, they can be offered Clozapine, the most effective pharmaceutical treatment for schizophrenia. The reason Clozapine is not first line treatment for schizophrenia is because it comes with several physical health risks and side effects. One of these is a change in blood levels of neutrophils - white blood cells - a part of our immune system. This leads to the risk for agranulocytosis, a life-threatening blood disorder that happens when the body does not make enough neutrophils. To monitor patients for this additional physical health risk while taking Clozapine, regular blood tests are essential.

A large reduction in the time it takes for blood test results

Traditionally it can take up to, or more than, five days to receive a patient’s blood test results and this does not even account for the additional time clinicians require to analyse the results and consider alternative care for patients. Involving colleagues from South London and Maudsley NHS Foundation Trust and King’s College London, we worked with Saladax who are developing new, small devices for rapid blood tests. With these new blood tests, patients can get their blood results almost straight away (within seven minutes) and discuss their results with clinicians on the same day.

Analysing the tests’ utility and effectiveness

To analyse the utility of these new tests, we ran a study, led by Prof Philip McGuire, Head of the Department of Psychosis Studies, and Prof David Taylor, Professor of Psychopharmacology, King’s College London, involving over 300 patients at South London and Maudsley NHS Foundation Trust. This study compared the new test to the traditional venous blood sampling. We also looked at the experiences of patients using this new system.

The study showed the new testing procedure provided accurate results within minutes.

There were several key outcomes from our patient survey:

Due to the increased speed in finding out their results and having only to have to come to clinic once and for one set of blood test results, patients reported feeling a lot more engaged with their health services.
The tests also supported clinicians because they allowed for more rapid decision making, better compliance and a better patient experience.
Due to the rapidity in which test results can be turned around, international treatment guidelines for Clozapine blood level testing are easier to adhere to and more actionable, because clinicians know the blood level results almost immediately.
Patients felt the process was more transparent. Patients would come in for their test, see their sample collected, observe it being tested, and almost immediately able to talk about the results with the nurse and the physician. This transparency could potentially result in better adherence to treatment.

Potential future impact

The study we conducted at the South London and Maudsley NHS Foundation Trust involving approximately 300 patients provides an evidence basis to use these rapid blood tests more widely. In terms of future impact, these blood tests could be used as a national standard at Clozapine clinics across the UK.

In addition, the technology used is not limited to blood testing for clozapine levels. The technology could also be used for effective testing of blood levels for other psychiatric medications and in other medical disciplines such as oncology and neurology.

Longer-term, the use of these blood tests could result in a huge reduction in treatment costs. Firstly, because visits are reduced from two to one, and if adherence is improved this can reduce appointments relating to patients not taking medication as prescribed.

Being part of King’s Health Partners

King’s Health Partners has played a critical role in our work. The team from South London and Maudsley NHS Foundation Trust clozapine clinics, involving healthcare professionals, clinicians and pharmacists, were incredibly supportive in running the study. The more than 300 samples for the study were turned around in a very short space of time – with the team delivering at an exceptional rate. Thank you to all my team and colleagues involved.

The King’s Health Partners Psychosis Clinical Academic Group brings together the largest group of psychosis expert clinicians, researchers, academics and clinical staff in the world.