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Partanen JJ, Häppölä P, Kämpe A, Ahola-Olli A, Hellsten A, Rask SM, Haaki W, Hietala J, Kampman O, Tiihonen J, Tanskanen AJ, Daly MJ, Ripatti S, Palotie A, Taipale H, Lähteenvuo M, Koskela JT. High Burden of Ileus and Pneumonia in Clozapine-Treated Individuals With Schizophrenia: A Finnish 25-Year Follow-Up Register Study. Am J Psychiatry 2024; 181:879-892. [PMID: 39262212 DOI: 10.1176/appi.ajp.20230744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE The authors used longitudinal biobank data with up to 25 years of follow-up on over 2,600 clozapine users to derive reliable estimates of the real-world burden of clozapine adverse drug events (ADEs). METHODS A total of 2,659 participants in the FinnGen biobank project had a schizophrenia diagnosis and clozapine purchases with longitudinal electronic health record follow-up for up to 25 years after clozapine initiation. Diseases and health-related events enriched during clozapine use were identified, adjusting for disease severity. The incidence and recurrence of ADEs over years of clozapine use, their effect on clozapine discontinuation and deaths, and their pharmacogenetics were studied. RESULTS Median follow-up time after clozapine initiation was 12.7 years. Across 2,157 diseases and health-related events, 27 were enriched during clozapine use, falling into five disease categories: gastrointestinal hypomotility, seizures, pneumonia, other acute respiratory tract infections, and tachycardia, along with a heterogeneous group including neutropenia and type 2 diabetes, among others. Cumulative incidence estimates for ileus (severe gastrointestinal hypomotility) and pneumonia were 5.3% and 29.5%, respectively, 20 years after clozapine initiation. Both events were significantly associated with increased mortality among clozapine users (ileus: odds ratio=4.5; pneumonia: odds ratio=2.8). Decreased genotype-predicted CYP2C19 and CYP1A2 activities were associated with higher pneumonia risk. CONCLUSIONS Clozapine-induced ileus and pneumonia were notably more frequent than has previously been reported and were associated with increased mortality. Two CYP genes influenced pneumonia risk. Pneumonia and ileus call for improved utilization of available preventive measures.
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Affiliation(s)
- Juulia J Partanen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Paavo Häppölä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Anders Kämpe
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Ari Ahola-Olli
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Anni Hellsten
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Susanna M Rask
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Willehard Haaki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jarmo Hietala
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Olli Kampman
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jari Tiihonen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Antti J Tanskanen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Mark J Daly
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Heidi Taipale
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Markku Lähteenvuo
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
| | - Jukka T Koskela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (Partanen, Häppölä, Kämpe, Daly, Ripatti, Palotie, Koskela), and Faculty of Medicine (Ripatti), University of Helsinki, Helsinki; Department of Molecular Medicine and Surgery (Kämpe) and Department of Clinical Neuroscience (Tiihonen, Tanskanen, Taipale), Karolinska Institutet, Stockholm; Department of Internal Medicine (Ahola-Olli) and Department of Psychiatry (Haaki, Hietala), Turku University Hospital, Turku, Finland; Aurora Hospital, City of Helsinki, Helsinki (Hellsten); Department of Psychiatry, Faculty of Medicine and Health Technology (Rask), and Faculty of Medicine and Health Technology (Kampman), Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, Tampere, Finland (Rask); Department of Psychiatry, University of Turku, Turku, Finland (Haaki, Hietala); Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden (Kampman); Department of Clinical Medicine, Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Ostrobothnia, Vaasa, Finland (Kampman); Department of Psychiatry, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kampman); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tiihonen, Tanskanen, Taipale, Lähteenvuo); Center for Psychiatry Research, Stockholm City Council, Stockholm (Tiihonen); Stanley Center for Psychiatric Research (Daly, Palotie) and Program in Medical and Population Genetics (Daly, Ripatti, Palotie), Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston (Daly, Ripatti, Palotie)
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De Las Cuevas C, de Leon VC, Blasco-Fontecilla H, Baca-García E, Sagud M, Sanz EJ, de Leon J. Clozapine may consistently protect from suicidal behaviors while other antipsychotics may lack a specific protective effect: a comprehensive VigiBase study interpreted in the context of the prior literature. Expert Opin Drug Saf 2024:1-11. [PMID: 39223773 DOI: 10.1080/14740338.2024.2399094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND In the United States, clozapine was first approved for treatment-resistant schizophrenia and then for suicidality in schizophrenia psychoses. Systematic reviews support clozapine's anti-suicidal effect, but the forensic literature stresses its lethality during overdoses. RESEARCH DESIGN AND METHODS Clozapine reports to the international pharmacovigilance database (VigiBase) were analyzed for suicidal ideation, suicide attempts, intentional overdose, and completed suicides from introduction to 1 January 2024. VigiBase uses the information component (IC) as a disproportionality analysis. RESULTS The clozapine ICs (range: other antipsychotics) were: 1) suicidal ideation IC = 0.570 with IC025 = 0.454 to IC975 = 0.680 (IC = 3.568 for aripiprazole and 1.729 for risperidone), 2) suicide attempt IC = 1.428 with IC025 = 1.323 to IC975 = 1.529 (IC = 4.150 for quetiapine and 2.968 for risperidone), 3) intentional overdose: IC = 0.995 with IC025 = 0.864 to IC975 = 1.120 (IC = 4.080 for quetiapine and 1.957 for aripiprazole), and 4) completed suicide IC = 1.133 with IC025 = 1.026 to IC975 = 1.235 (IC = 4.648 for quetiapine and 2.160 for risperidone). In summary, all clozapine ICs were significantly lower. We found 2391 clozapine-treated patients on the suicidality spectrum (627 cases with suicidal ideation, 752 with suicide attempt, 488 with intentional overdose, and 731 with completed suicide) but many were taking other antipsychotics. The most frequent reporting countries were the United States, the United Kingdom, and Croatia. CONCLUSION This pharmacovigilance study, with all its inherent limitations, provides independent proof, not overlapping with prior literature, that clozapine may have specific strong anti-suicidal effects that do not appear to be present in other antipsychotics. Further VigiBase studies are needed to compare the lethality of an intentional overdose of clozapine (14.3%) with other antipsychotics.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology, and Psychiatry and Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, La Laguna, Spain
| | - Victoria C de Leon
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Hilario Blasco-Fontecilla
- Instituto de Investigación, Transferencia e Innovación, Ciencias de la Saludy Escuela de Doctorado, Universidad Internacional de La Rioja, Logroño, Spain
- Emooti, Madrid, Spain
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
| | - Enrique Baca-García
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, Hospital Fundación Jiménez Díaz, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Marina Sagud
- School of Medicine, University of Zagreb, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Spain
- Hospital Universitario de Canarias, Tenerife, Spain
| | - Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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de Leon J, Ruan CJ, Schoretsanitis G, Villasante-Tezanos AG, Spina E, Sanz EJ, Betancort M, De Las Cuevas C. Investigating in VigiBase over 6000 cases of pneumonia in clozapine-treated patients in the context of the literature: focus on high lethality and the association with aspiration pneumonia. Expert Opin Drug Metab Toxicol 2024:1-15. [PMID: 38920369 DOI: 10.1080/17425255.2024.2373111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The literature associates clozapine with pneumonia/aspiration pneumonia. RESEARCH DESIGN AND METHODS The international pharmacovigilance database (VigiBase™) uses the information component (IC) as statistical signal. VigiBase clozapine reports were analyzed for pneumonia/aspiration pneumonia from introduction to 10 May 2023. RESULTS There were 6392 cases of all types of pneumonia (5572 cases of pneumonia, 775 of aspiration pneumonia, and 45 combined). The IC was 3.52 for aspiration pneumonia, introduced as a VigiBase label in 2003, and 1.91 for pneumonia. Patients were reclassified as 3628 with no signs of aspiration and 1533 with signs. Signs of aspiration were strongly associated with some co-medications: olanzapine, odds ratio (OR) = 23.8, 95% confidence interval (CI), 14.9-38.0; risperidone OR = 18.6, CI, 11.4-30.4; valproic acid, OR = 5.5, CI, 4.5-6.6; and benzodiazepines OR = 5.5, CI, 4.5-6.6. In 2415 cases with completed data, fatal outcomes made up 45% (signs of aspiration made no difference), but there was wide variability from 0% (females <45 years of age; duration ≤30 days) to 76% (males >64 years of age; duration >1 year). During the first week, pneumonia was associated with 1) very high titration doses, 2) very small doses in Parkinson's disease, and 3) Japan vs other countries. CONCLUSIONS In clozapine-treated patients: 1) at least 30% of pneumonia cases may be aspiration pneumonia, 2) stopping some co-medications may decrease the risk of aspiration pneumonia, 3) average lethality in pneumonia was 45% but may be around 75% in geriatric patients with long-term treatment, and 4) safer titrations may sometimes require 5-mg tablets.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Moisés Betancort
- Department of Clinical Psychology, Psychobiology, and Methodology, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, La Laguna, Canary Islands, Spain
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De Las Cuevas C, Sanz EJ, de Leon J. Adverse drug reactions and their fatal outcomes in clozapine patients in VigiBase: Comparing the top four reporting countries (US, UK, Canada and Australia). Schizophr Res 2024; 268:165-174. [PMID: 37301669 DOI: 10.1016/j.schres.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pharmacovigilance findings and box warnings in the clozapine package inserts have marked the history of clozapine. OBJECTIVE This is the largest review of clozapine adverse drug reactions (ADRs) and their associated fatal outcomes. Reports to the World Health Organization's global pharmacovigilance database, VigiBase™, were analyzed, extending from clozapine's introduction to December 31, 2022. METHODS The analysis focused on the top four reporting countries: United States (US), United Kingdom (UK), Canada and Australia (83 % of fatal outcomes worldwide). Attempts were made to control for population and clozapine prescription in each country. RESULTS Clozapine ADRs worldwide accounted for 191,557 reports, with the highest number (53,505) in "blood and lymphatic system disorder". Of the 22,596 fatal outcomes reported in clozapine patients, 9587 were from the US, 6567 from the UK, 3623 from Canada and 1484 from Australia. The top category worldwide in fatal outcomes was nonspecifically labeled "death" with 46 % (range 22-62 %). "Pneumonia" was second with 30 % (range 17-45 %). Agranulocytosis was numerically only the 35th top clozapine ADR associated with fatal outcomes. On average, 2.3 clozapine ADRs were reported per fatal outcome. Infections were associated with 24.2 % of the UK fatal outcomes (9.4 %-11.9 % in the 3 other countries). CONCLUSIONS The four countries appeared to report clozapine ADRs in different ways, making comparisons difficult. We estimated higher fatal outcomes in the UK and Canada after controlling for cross-sectional estimations of population and published clozapine use. This last hypothesis is limited by the lack of precise estimation of accumulated clozapine use in each country.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain; Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain.
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain; Hospital Universitario de Canarias, Tenerife, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain.
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Kirilochev O, Chumakov E, Kuzo N, Schoretsanitis G. A scoping review of literature on clozapine from former USSR states published in Russian language. Schizophr Res 2024; 268:38-47. [PMID: 37741739 DOI: 10.1016/j.schres.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Access to literature on clozapine in Russian language remains strikingly limited. We aimed to identify and translate clinical evidence on clozapine-based treatment outcomes. METHODS We performed a systematic review in PubMed, Embase and scientific indexes from former USSR states searching for articles published in Russian from the database inception till January 2023 and summarized the data in a scoping review (PROSPERO Reg. Number CRD42023386737). RESULTS A total of 60 papers were included comprising eight main topic categories: 1) clozapine-related intoxications (n = 20), 2) effectiveness/efficacy and safety of clozapine treatment (n = 14), 3) adverse drug-induced reactions (ADRs) related to clozapine treatment (n = 9), 4) therapeutic drug monitoring for clozapine (n = 5), 5) combination of clozapine and non-pharmacological treatments (n = 4), 6) pharmacoepidemiology of clozapine (n = 3), 7) effects of clozapine on the brain electrical activity (n = 3), and 8) novel clozapine formulations (n = 2). Among clozapine-related intoxications there were reports of criminal poisoning, which was associated with low lethality. Worse outcomes were accompanied by systemic reactions to intoxications. Clinical benefits of hemoadsorption were reported in the management of clozapine-related intoxications. Only half of studies reporting clozapine effectiveness used standardized scales to assess outcomes. Clozapine superiority in treatment-resistant schizophrenia (TRS) was replicated in one trial. No reports of clozapine-related agranulocytosis were identified. Clozapine ranked among most prescribed antipsychotics for TRS and non-TRS. CONCLUSIONS As clinical research in former USSR states is advancing to adopt western clinical research standards, comparability and extrapolation of findings is expected to increase, with transfer of older findings to clinical practice being particularly challenging.
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Affiliation(s)
- Oleg Kirilochev
- Department of Clinical Pharmacology, Astrakhan State Medical University, Astrakhan, Russian Federation.
| | - Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Nazar Kuzo
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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de Leon J. Promoting safer and wider worldwide use of clozapine. Schizophr Res 2024; 268:1-6. [PMID: 38519290 DOI: 10.1016/j.schres.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This issue focuses on the past, the present and the future of clozapine. Of the 43 clozapine articles, nine are historical articles dealing with the past, 29 deal with the present and five with laboratory assays which may influence its future use. These 43 articles include 219 different authors from 56 countries/regions and five continents.
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Affiliation(s)
- Jose de Leon
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA; Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain.
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Kersting XAK, Momtahen N, Lieb K. Clozapine Serum Concentrations Are Disrupted by SARS-CoV-2 Vaccinations. Case Rep Psychiatry 2023; 2023:9914879. [PMID: 38058314 PMCID: PMC10696469 DOI: 10.1155/2023/9914879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
This paper reports the case of a 27-year-old man with paranoid schizophrenia who was finally stabilized on clozapine medication. After vaccination against severe acute respiratory syndrome coronavirus 2, serum levels of clozapine increased. It is well established that immune responses can trigger cytokine cascades affecting drug metabolism, which, in the case of clozapine treatment, can lead to severe intoxication.
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Affiliation(s)
- Xenia A. K. Kersting
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Nicoletta Momtahen
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
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Guo X, Chen J, Wang W, Jiang B, Liang B. Treatment of severe tardive dyskinesia with concurrent administration of olanzapine, clonazepam, baclofen, and gabapentin: a case report. J Int Med Res 2023; 51:3000605231195154. [PMID: 37812512 PMCID: PMC10563481 DOI: 10.1177/03000605231195154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/31/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Long-term use of antipsychotics or other dopamine antagonists can result in the extrapyramidal side effect of tardive dyskinesia (TD).Case presentation: An 18-year-old female patient experienced abnormal speech and behavior and because of an equivocal diagnosis, she was given daily doses of 300 mg of quetiapine and 60 mg of ziprasidone. She had used these medications for 2 years before the appearance of involuntary abnormal movements. These movements, which were classified as TD, steadily worsened and markedly interfered with her daily life. Following a trial-and-error course of therapy with vitamin E, vitamin B6, amantadine, valproic acid sodium, lorazepam, and diazepam, the drugs were gradually reduced and stopped, yet the aberrant movements persisted. Finally, the patient was given olanzapine, clonazepam, baclofen, and gabapentin. The Abnormal Involuntary Movement Scale was used to assess changes in the patient's condition. Her TD was efficiently managed through co-administration of olanzapine, clonazepam, baclofen, and gabapentin. CONCLUSIONS The possibility of TD inducing by antipsychotic use is a clinical concern, even though atypical antipsychotics decrease the incidence of extrapyramidal side effects, and it cannot be entirely excluded. This report provides useful insights into the management of TD and will help clinicians manage similar cases.
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Affiliation(s)
- Xiaoling Guo
- Department of Mental Health, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
| | - Jiong Chen
- Department of Mental Health, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
| | - Weixin Wang
- Department of Mental Health, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
| | - Bo Jiang
- Department of Mental Health, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
| | - Bo Liang
- Department of Mental Health, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
- Department of Oncology, Tongde Hospital of Zhejiang Province, Mental Health Center of Zhejiang Province, Hangzhou, China
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Jones R, Morales-Munoz I, Shields A, Blackman G, Legge SE, Pritchard M, Kornblum D, MacCabe JH, Upthegrove R. Early neutrophil trajectory following clozapine may predict clozapine response - Results from an observational study using electronic health records. Brain Behav Immun 2023; 113:267-274. [PMID: 37494985 DOI: 10.1016/j.bbi.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Clozapine has unique effectiveness in treatment-resistant schizophrenia and is known to cause immunological side-effects. A transient spike in neutrophils commonly occurs in the first weeks of clozapine therapy. There is contradictory evidence in the literature as to whether neutrophil changes with clozapine are linked to treatment response. AIMS The current study aims to further examine the neutrophil changes in response to clozapine and explore any association between neutrophil trajectory and treatment response. METHODS A retrospective cohort study of patients undergoing their first treatment with clozapine and continuing for at least 2 years identified 425 patients (69% male/31% female). Neutrophil counts at baseline, 3 weeks and 1 month were obtained predominantly by linkage with data from the clozapine monitoring service. Clinical Global Impression- Severity (CGI-S) was rated from case notes at the time of clozapine initiation and at 2 years. Latent class growth analysis (LCGA) was performed to define distinct trajectories of neutrophil changes during the first month of treatment. Logistic regression was then conducted to investigate for association between the trajectory of neutrophil count changes in month 1 and clinical response at 2 years as well as between baseline neutrophil count and response. RESULTS Of the original cohort, 397 (93%) patients had useable neutrophil data during the first 6 weeks of clozapine treatment. LCGA revealed significant differences in neutrophil trajectories with a three-class model being the most parsimonious. The classes had similar trajectory profiles but differed primarily on overall neutrophil count: with low, high-normal and high neutrophil classes, comprising 52%, 40% and 8% of the sample respectively. Membership of the high-normal group was associated with significantly increased odds of a positive response to clozapine, as compared to the low neutrophil group [Odds ratio (OR) = 2.10, p-value = 0.002; 95% confidence interval (95% CI) = 1.31-3.36]. Baseline neutrophil count was a predictor of response to clozapine at 2 years, with counts of ≥5 × 109/l significantly associated with positive response (OR = 1.60, p-value = 0.03; 95% CI = 1.03-2.49). CONCLUSIONS Our data are consistent with the hypothesis that patients with low-level inflammation, reflected in a high-normal neutrophil count, are more likely to respond to clozapine, raising the possibility that clozapine exerts its superior efficacy via immune mechanisms.
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Affiliation(s)
- Rowena Jones
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, UK.
| | | | - Adrian Shields
- Clinical Immunology Service, University of Birmingham, UK
| | - Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, UK; Department of Psychosis Studies, King's College London, and South London and Maudsley NHS Foundation Trust, UK
| | - Sophie E Legge
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Daisy Kornblum
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - James H MacCabe
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK; Department of Psychosis Studies, King's College London, and South London and Maudsley NHS Foundation Trust, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Trust, UK
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de Leon J, Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, Kopeček M, Švancer P, Olmos I, Ricciardi C, Iglesias-Garcia C, Iglesias-Alonso A, Spina E, Ruan CJ, Wang CY, Wang G, Tang YL, Lin SK, Lane HY, Kim YS, Kim SH, Rajkumar AP, González-Esquivel DF, Jung-Cook H, Baptista T, Rohde C, Nielsen J, Verdoux H, Quiles C, Sanz EJ, De las Cuevas C, Cohen D, Schulte PF, Ertuğrul A, Anıl Yağcıoğlu AE, Chopra N, McCollum B, Shelton C, Cotes RO, Kaithi AR, Kane JM, Farooq S, Ng CH, Bilbily J, Hiemke C, López-Jaramillo C, McGrane I, Lana F, Eap CB, Arrojo-Romero M, Rădulescu FŞ, Seifritz E, Every-Palmer S, Bousman CA, Bebawi E, Bhattacharya R, Kelly DL, Otsuka Y, Lazary J, Torres R, Yecora A, Motuca M, Chan SKW, Zolezzi M, Ouanes S, De Berardis D, Grover S, Procyshyn RM, Adebayo RA, Kirilochev OO, Soloviev A, Fountoulakis KN, Wilkowska A, Cubała WJ, Ayub M, Silva A, Bonelli RM, Villagrán-Moreno JM, Crespo-Facorro B, Temmingh H, Decloedt E, Pedro MR, Takeuchi H, Tsukahara M, Gründer G, Sagud M, Celofiga A, Ignjatovic Ristic D, Ortiz BB, Elkis H, Pacheco Palha AJ, Llerena A, Fernandez-Egea E, Siskind D, Weizman A, Masmoudi R, Mohd Saffian S, Leung JG, Buckley PF, Marder SR, Citrome L, Freudenreich O, Correll CU, Müller DJ. Guía internacional para una dosificación más segura de la clozapina en adultos mediante el uso de 6 titulaciones personalizadas de dosis basados en la etnicidad, la proteína C reactiva y los niveles de clozapina. PSIQUIATRÍA BIOLÓGICA 2023; 30:100415. [DOI: 10.1016/j.psiq.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
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11
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Berger SJ, Hofer A. [Safety aspects during treatment with clozapine. : Monitoring and rechallenge - a narrative review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:130-135. [PMID: 37389803 PMCID: PMC10491511 DOI: 10.1007/s40211-023-00473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Due to its unique efficacy in treatment-resistant schizophrenia, discontinuation of treatment with clozapine is frequently associated with a significant worsening of symptoms, but also with an increased risk of suicide. Based on the literature, this review aims at summarizing different monitoring recommendations in order to be able to continue this therapy despite the occurrence of side effects. In addition, we provide recommendations when rechallenge of a previously stopped treatment with clozapine can be considered and when a definite discontinuation must take place. MATERIAL AND METHODS Medline, the Guideline for the use of clozapine 2013 of the Netherlands Clozapine Collaboration Group, and the S3 Guideline for Schizophrenia of the German Association of Psychiatry, Psychotherapy and Psychosomatics were searched for relevant literature, the last query dating from April 28th, 2023. RESULTS If agranulocytosis or cardiomyopathy develops, treatment with clozapine must be discontinued and should not be resumed thereafter. In contrast, treatment with clozapine which had to be discontinued due to myocarditis or prolongation of the QTc interval may be continued if left ventricular function is normal or after normalization of the QTc interval. Other side effects are usually not absolute contraindications for rechallenge but often require the adjunctive use of additional pharmacologic and non-pharmacologic measures. CONCLUSION Taking into consideration various monitoring recommendations, cessation of treatment with clozapine can often be prevented or treatment with clozapine that has been discontinued due to side effects can be resumed.
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Affiliation(s)
- Stefan J Berger
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Alex Hofer
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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12
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Berger SJ, Hofer A. [Safety aspects during treatment with clozapine: : Adverse effects, titration, and therapeutic drug monitoring - a narrative review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:122-129. [PMID: 37349671 PMCID: PMC10491532 DOI: 10.1007/s40211-023-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND According to current guidelines, clozapine should be used as a third step in treatment resistant schizophrenia (TRS). In everyday clinical practice, however, it is frequently used at a much later stage, which leads to a significant deterioration of prognosis. The first part of this narrative overview focuses on the most frequent side effects of clozapine, on the relevance of slow titration, and on specific aspects of therapeutic drug monitoring (TDM). MATERIAL AND METHODS Medline, the Guideline for the use of clozapine 2013 of the Netherlands Clozapine Collaboration Group, and the S3 Guideline for Schizophrenia of the German Association for Psychiatry, Psychotherapy and Psychosomatics were searched for relevant literature, the last query dating from April 28th, 2023. RESULTS Despite its unique efficacy clozapine is underused in clinical practice and prescription varies between and within countries. Next to hematological, metabolic, and vegetative side effects, clozapine induced inflammation manifesting in the form of pneumonia or myocarditis, which is mainly associated with rapid titration, represents a major clinical challenge with CRP monitoring being of particular relevance. In this context, it also has to be noted that sex, smoking behavior, and ethnic origin impact clozapine metabolism, thus requiring personalized dosing. CONCLUSION Slow titration when possible, TDM, and CYP diagnostics when appropriate increase patient safety during treatment with clozapine and thus the likelihood of early prescription of this compound in TRS.
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Affiliation(s)
- Stefan J Berger
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Alex Hofer
- Department für Psychiatrie, Psychotherapie, Psychosomatik und Medizinische Psychologie, Univ.-Klinik für Psychiatrie I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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13
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Wagner E, Siskind D, Falkai P, Howes O, Correll C, Lee J, Honer WG, Kane JM, Fernandez-Egea E, Barnes TRE, Hasan A. Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group. Schizophr Bull 2023; 49:962-972. [PMID: 36943247 PMCID: PMC10318876 DOI: 10.1093/schbul/sbad030] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND HYPOTHESIS There is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for the optimization of clozapine monotherapy. STUDY DESIGN We conducted an online Delphi survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group comprising experts from twenty-nine countries. The threshold criterion for a consensus recommendation was ≥ 75% agreement ("agree" and "strongly agree" responses) on a question. Agreement of ≥ 50% but < 75% in a second or third Delphi round was deemed to provide guidance. STUDY RESULTS Forty-nine (first round), 32 (second round), and 48 (third round) of the 91 current TRRIP members participated. Expert recommendations at ≥ 75% comprised second-line treatment with clozapine in cases of persistent positive symptoms with co-occurring extrapyramidal symptoms, tardive dyskinesia, or suicidality/aggression. There was considerable disagreement on myocarditis screening parameters. The management of somatic and neuropsychiatric adverse drug reactions warrants further research for more evidence-based recommendations. Rechallenge with clozapine was recommended for eosinophilia, sinus tachycardia and fever and guidance (agreement ≥ 50%) was reached for pneumonia and thrombocytopenia. CONCLUSIONS Given the limited evidence available, this consensus-based series of recommendations and guidance statements supports clinical decision-making to optimize clozapine monotherapy and provides guidance for future research in treatment-resistant schizophrenia.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Dan Siskind
- Department of Psychiatry, School of Medicine, University of Queensland, Brisbane, Australia
- Mobile Intensive Rehabilitation Team, Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christoph Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute for Behavioral Science, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
| | - Jimmy Lee
- Department of Psychosis, Institute of Mental Health, Singapore
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - William G Honer
- Department of Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute for Behavioral Science, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Emilio Fernandez-Egea
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany
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14
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De Las Cuevas C, Sanz EJ, Villasante-Tezanos AG, de Leon J. Respiratory aspiration during treatment with clozapine and other antipsychotics: a literature search and a pharmacovigilance study in VigiBase. Expert Opin Drug Metab Toxicol 2023; 19:57-74. [PMID: 36920343 DOI: 10.1080/17425255.2023.2192401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Antipsychotics (APs), during treatment or overdose, may be associated with respiratory aspiration. AREAS COVERED A PubMed search on September 30, 2022, provided 3 cases of respiratory aspiration during clozapine therapy and 1 case during an AP overdose. VigiBase records of respiratory aspiration associated with APs from inception until September 5, 2021, were reviewed. VigiBase, the World Health Organization's global pharmacovigilance database, uses a statistical signal for associations called the information component (IC). EXPERT OPINION The ICs (and IC025) were 2.1 (and 2.0) for APs, 3.2 (and 3.0) for clozapine, 2.6 (and 2.4) for quetiapine, and 2.5 (and 2.2) for olanzapine. Cases of respiratory aspiration associated with APs included: 137 overdose/suicide cases (64 fatal) and 609 cases during treatment (385 fatal) including 333 taking clozapine (238 fatal). In logistic regression models of fatal outcomes, the odds ratios, OR, and (95% confidence intervals, CI) of significant independent variables were: a) 2.3 - 2.6 for clozapine in 3 samples of AP treatment of varying size, b) 1.9 (CI 1.0 to 3.5) for geriatric age in 284 patients on clozapine treatment, and c) 1.8 (CI 1.1 - 3.2) for antidepressant co-medication in 276 patients on non-clozapine APs. Multiple AP pharmacological mechanisms may explain respiratory aspiration.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain.,Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain.,Hospital Universitario de Canarias, Tenerife, Spain
| | - Alejandro G Villasante-Tezanos
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, United States.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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15
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Leung JG. Part
II
: Interactive case—Clinical pearls of clozapine. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2023. [DOI: 10.1002/jac5.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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16
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de Leon J. Reflections on the Lack of Consideration of Ethnic Ancestry to Stratify Clozapine Dosing. Psychiatry Investig 2023; 20:183-195. [PMID: 36850057 PMCID: PMC10064212 DOI: 10.30773/pi.2022.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 03/01/2023] Open
Abstract
This review article argues against trusting standard clozapine references, including the US package insert, because they do not include advances in the sciences of pharmacokinetics and pharmacovigilance and ignore the effects of ethnic ancestry on therapeutic dosing. The minimum therapeutic dose leading to the minimum therapeutic concentration of 350 ng/mL in serum/plasma can be used to compare individuals/groups with treatment-resistant schizophrenia. The US clozapine package insert recommends targeting doses of 300-450 mg/day and, subsequently, increments of up to 100 mg with a maximum dose of 900 mg/day. Ethnic ancestry is defined by DNA ancestry group. Asians (people with ancestry ranging from Pakistan to Japan) and Indigenous Americans are similar in clozapine dosing; their average clozapine minimum therapeutic dose ranged from 166 mg/day (female non-smokers) to 270 mg/day (male smokers). For those with European ancestry, average clozapine minimum therapeutic doses ranged from 236 mg/day (female non-smokers) to 368 mg/day (male smokers). Based on limited studies, Black (African sub-Saharan ancestry) patients may be treated with typical US doses (300-600 mg/day), assuming no poor metabolism (PM) status. Ancestry's impact on clozapine lethality in four countries is discussed (two countries with highly homogenous populations, Denmark and Japan, and two countries with increasingly heterogenous populations due to immigration, Australia and the UK). An international guideline with 104 authors from 50 countries/regions was recently published, providing 6 personalized clozapine titration schedules for adult inpatients (3 ancestry groups and PM/non-PM schedules) and recommending c-reactive protein monitoring at baseline and weekly for 4 weeks.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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17
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Leung JG, Ehret M, Love RC, Cotes RO. Improving clozapine utilization will require continued advocacy, drug sponsor interest, and FDA support to address REMS issues. Expert Rev Clin Pharmacol 2023; 16:177-179. [PMID: 36803289 DOI: 10.1080/17512433.2023.2183192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
| | - Megan Ehret
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Raymond C Love
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Robert O Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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18
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Copeland CS, Wallman P, Morgan D, Owen E, Taylor D. A case-control study of antipsychotic use and pneumonia-related mortality in the United Kingdom. Acta Psychiatr Scand 2023; 147:301-313. [PMID: 36651563 DOI: 10.1111/acps.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIM There is increasing evidence linking antipsychotic use with pneumonia, but limited evidence of an effect on pneumonia-related outcomes such as mortality. In this study, we aimed to examine the association of pneumonia-related death with specific antipsychotic exposure. METHOD Deaths analysed were those reported to a UK-based drug-related deaths database, the National Programme on Substance Abuse Deaths (NPSAD), between 1997 and September 2020. We conducted a case-control study with cases defined as pneumonia-related deaths and controls as cases with alternative causes of death. Cases were analysed by considering drugs detected at post-mortem (PM) and by drugs prescribed to the deceased at the time of their death with calculated odds ratios (ORs) adjusted to account for confounders. RESULTS There were 2467 PM cases and 40,128 controls; 1818 prescribed cases and 28,018 controls. Second generation antipsychotics (SGAs) were robustly associated with an increased risk of pneumonia-related death compared with those not prescribed or taking antipsychotics (PM detection adjusted OR [AOR] 1·34 [95% CI 1·15-1·55]; prescribed AOR 1·28 [95% CI 1·11-1·49]). First generation antipsychotics had no clear association with death from pneumonia (PM detection AOR 1·06 [95% CI 0·77-1·47]; prescribed AOR 0·91 [95% CI 0·71-1·17]). Amongst SGAs, olanzapine was associated with an increased risk of death due to pneumonia (PM detection AOR 1·49 [95% CI 1·22-1·82]; prescribed AOR 1·44 [95% CI 1·18-1·76]) as was quetiapine (PM detection AOR 1·34 [95% CI 1·07-1·66]; prescribed AOR 1·28 [95% CI 1·01-1·64]). CONCLUSION Olanzapine and quetiapine were found to increase the risk of pneumonia-related death in this NPSAD sample to a clinically important extent.
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Affiliation(s)
- Caroline S Copeland
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Centre for Pharmaceutical Medicine Research, King's College London, London, UK
| | - Phoebe Wallman
- Divisons of Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Morgan
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Centre for Pharmaceutical Medicine Research, King's College London, London, UK
| | - Eleanor Owen
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - David Taylor
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Divisons of Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust, London, UK
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19
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The Modernization of Clozapine: A Recapitulation of the Past in the United States and the View Forward. J Clin Psychopharmacol 2022; 42:565-580. [PMID: 36170148 DOI: 10.1097/jcp.0000000000001606] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although clozapine was Food and Drug Administration (FDA) approved more than 3 decades ago, major barriers and gaps in knowledge continue to prevent its effective and safe use. We review modern-day problems encountered with clozapine in the United States (US). METHODS Information surrounding current administrative, clinical, research, and technological gaps or barriers related to clozapine use in the US was reviewed. FINDINGS The history of how clozapine became FDA approved likely contributes to gaps in knowledge. The frequency of safety warnings added to the FDA prescribing information may add to fears about clozapine, as evidence by numerous published survey studies. The clozapine Risk Evaluation and Mitigation Strategy (REMS) program has been modified several times in the last decade, causing access and safety issues for patients, which are discussed. Evidence may suggest that the FDA REMS requirements for hematologic monitoring are too cumbersome, and there may be ability to safely loosen requirements. The COVID-19 pandemic brought forth the ability for extended interval monitoring but also greater awareness of the clozapine-inflammation interaction. Newer guidelines published describe considerations in personalizing clozapine titration based on principles of ethnopsychopharmacology. Emerging technologies to support the use of clozapine are not widely available. IMPLICATIONS Clozapine is a unique life-saving drug but it is underused in the US, despite its established efficacy. The 2021 REMS changes led to significant difficulties for providers and patients. We highlight the importance of the clozapine-inflammation interaction, therapeutic drug monitoring, and the ability for individual care based on patient-specific factors. There is an urgent need for advancing technology used for clozapine monitoring, evaluating barriers created by REMS, and establishing consistent practices throughout the US.
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Sampogna G, Borgi M, Collacchi B, Cirulli F, Cerino S, Rullo S, Di Vincenzo M, Luciano M, Di Tommaso V, Moliterni S, Bichi A, Garside J, Kivistö S, Iarion A, Fiorillo A. Using sport-based interventions for people with severe mental disorders: results from the European EASMH study. Int Rev Psychiatry 2022; 34:837-847. [PMID: 36786110 DOI: 10.1080/09540261.2022.2106122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marta Borgi
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Francesca Cirulli
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Santo Rullo
- European Culture and Sport Organization, ECOS, Rome; Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | | | - Alberto Bichi
- The European Platform for Sport Innovation, EPSI, Brussels; Belgium
| | | | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
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21
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Cascino G, Ceres R, Monteleone AM, Bucci P, Giordano GM, Galderisi S, Monteleone P. Switching Antipsychotic Medications in People with Schizophrenia: A 4-Year Naturalistic Study. J Clin Med 2022; 11:5965. [PMID: 36233835 PMCID: PMC9573332 DOI: 10.3390/jcm11195965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022] Open
Abstract
Although generally effective in ameliorating the core manifestations of schizophrenia, antipsychotics (APs) may lead to only suboptimal responses or may be associated with a variety of treatment-related adverse events which require additional treatment strategies. Under such clinical circumstances, switching APs represents a rational treatment option. The present study aimed to identify the variables that predict AP switch and to quantify the frequency of this phenomenon in people with schizophrenia in real-life. A secondary analysis was conducted on the data collected at baseline and at a 4-year follow-up from a large sample of community-dwelling Italian people with schizophrenia. Demographic and clinical variables as well as information about AP treatment were recorded at two time points. Over the 4-year period, 34.9% of the 571 participants switched the AP; in particular, 8.4% of participants switched from first-generation APs (FGAs) to second-generation APs or vice versa, while 8.2% of them switched to clozapine. Logistic regression models showed that combination of APs at baseline was negatively associated with AP switch, while treatment with FGAs and the presence of extrapyramidal symptoms at baseline were associated with AP class switch. Although the aim of the present study was not to assess predictors of clinical relapse in people with schizophrenia, we might speculate that switching APs represents a surrogate indicator of treatment failure in some patients and could lead into relapse, which is a costly aspect of schizophrenia management in both economic and human terms. The sooner such a negative outcome can be predicted and managed, the sooner the treatment can be optimized to avoid it.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, 84131 Salerno, Italy
| | - Rossella Ceres
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, 84131 Salerno, Italy
| | | | - Paola Bucci
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, 84131 Salerno, Italy
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22
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De Las Cuevas C, Sanz EJ, de Leon J. Respiratory aspiration during treatment with benzodiazepines, antiepileptic and antidepressant drugs in the pharmacovigilance database from VigiBase. Expert Opin Drug Metab Toxicol 2022; 18:541-553. [PMID: 36073179 DOI: 10.1080/17425255.2022.2122813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Three psychotropic drug classes, benzodiazepines, antiepileptic drugs (AEDs) and antidepressants (ADs), whether used in treatment or overdose, may be associated with respiratory aspiration. Polypharmacy was defined by counting suspected drugs from these classes or two others, antipsychotics and opioids. The confounding effects of polypharmacy were considered in this study. AREAS COVERED VigiBase records of respiratory aspiration associated with benzodiazepines, AEDs, and/or ADs from inception until September 5, 2021, were reviewed. VigiBase, the World Health Organization's global pharmacovigilance database, uses a statistical signal for associations called the information component (IC). EXPERT OPINION The ICs (and IC025) were benzodiazepines 2.8 (and 2.6), AEDs 1.6 (and 1.5), and ADs 1.4 (and 1.3). The cases of respiratory aspiration associated with at least one drug from these 3 classes included: 1) 553 cases absent any known overdose (2.8±1.7 drugs) and 2) 347 overdose cases (2.9±1.8 drugs). Little support for the association of respiratory aspiration and benzodiazepine, AED or AD monotherapy in therapeutic dosages was found. Studies of the association between benzodiazepine monotherapy and respiration aspiration are needed in geriatric patients. ADs added to other medications increased lethality in all cases of respiratory aspiration including those associated with overdose, polypharmacy and/or major medical problems.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain.,Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain.,Hospital Universitario de Canarias, Tenerife, Spain
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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23
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Correll CU, Agid O, Crespo-Facorro B, de Bartolomeis A, Fagiolini A, Seppälä N, Howes OD. A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia. CNS Drugs 2022; 36:659-679. [PMID: 35759211 PMCID: PMC9243911 DOI: 10.1007/s40263-022-00932-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
Treatment-resistant schizophrenia (TRS) will affect about one in three patients with schizophrenia. Clozapine is the only treatment approved for TRS, and patients should be treated as soon as possible to improve their chances of achieving remission. Despite its effectiveness, concern over side effects, monitoring requirements, and inexperience with prescribing often result in long delays that can expose patients to unnecessary risks and compromise their chances of achieving favorable long-term outcomes. We critically reviewed the literature on clozapine use in TRS, focusing on guidelines, systematic reviews, and algorithms to identify strategies for improving clozapine safety and tolerability. Based on this, we have provided an overview of strategies to support early initiation of clozapine in patients with TRS based on the latest evidence and our clinical experience, and have summarized the key elements in a practical, evidence-based checklist for identifying and managing patients with TRS, with the aim of increasing confidence in prescribing and monitoring clozapine therapy.
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Affiliation(s)
- C U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Ofer Agid
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Andrea de Bartolomeis
- Section on Clinical Psychiatry and Psychology, Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, University of Naples Federico II, Naples, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Niko Seppälä
- Department of Psychiatry Satasairaala, Harjavalta, Finland
| | - Oliver D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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24
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Han J, Lv Z, Shen M, Wan Q, Xiao L, Wang G. Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital. Am J Infect Control 2022; 51:446-453. [PMID: 35728721 DOI: 10.1016/j.ajic.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital. METHODS This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017 and July 31, 2021 (excluding January 1, 2020 to May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation and hospital ward. RESULTS The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% on closed wards, 0.75% on open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorder, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use and mood stabilizer use. CONCLUSION HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors or mood stabilizers.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Zhihua Lv
- Department of Clinical laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Meiyu Shen
- Department of Mental Health Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Qirong Wan
- Department of Clinical Psychology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Ling Xiao
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
| | - Gaohua Wang
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
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25
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Lee MT, Mouri A, Kubota H, Lee HJ, Chang MH, Wu CY, Knutson DE, Mihovilovic M, Cook J, Sieghart W, Nabeshima T, Chiou LC. Targeting α6GABA A receptors as a novel therapy for schizophrenia: A proof-of-concept preclinical study using various animal models. Biomed Pharmacother 2022; 150:113022. [PMID: 35483195 DOI: 10.1016/j.biopha.2022.113022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
GABAA receptors containing α6 subunits (α6GABAARs) in the cerebellum have -been implicated in schizophrenia. It was reported that the GABA synthesizing enzymes were downregulated whereas α6GABAARs were upregulated in postmortem cerebellar tissues of patients with schizophrenia and in a rat model induced by chronic phencyclidine (PCP). We have previously demonstrated that pyrazoloquinolinone Compound 6, an α6GABAAR-highly selective positive allosteric modulator (PAM), can rescue the disrupted prepulse inhibition (PPI) induced by methamphetamine (METH), an animal model mimicking the sensorimotor gating deficit based on the hyper-dopaminergic hypothesis of schizophrenia. Here, we demonstrate that not only Compound 6, but also its structural analogues, LAU463 and LAU159, with similarly high α6GABAAR selectivity and their respective deuterated derivatives (DK-I-56-1, DK-I-58-1 and DK-I-59-1) can rescue METH-induced PPI disruption. Besides, Compound 6 and DK-I-56-I can also rescue the PPI disruption induced by acute administration of PCP, an animal model based on the hypo-glutamatergic hypothesis of schizophrenia. Importantly, Compound 6 and DK-I-56-I, at doses not affecting spontaneous locomotor activity, can also rescue impairments of social interaction and novel object recognition in mice induced by chronic PCP treatments. At similar doses, Compound 6 did not induce sedation but significantly suppressed METH-induced hyperlocomotion. Thus, α6GABAAR-selective PAMs can rescue not only disrupted PPI but also hyperlocomotion, social withdrawal, and cognitive impairment, in both METH- and PCP-induced animal models mimicking schizophrenia, suggesting that they are a potential novel therapy for the three core symptoms, i.e. positive symptoms, negative symptoms, and cognitive impairment, of schizophrenia.
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Affiliation(s)
- Ming Tatt Lee
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Akihiro Mouri
- Department of Regulatory Science, Fujita Health University Graduate School of Health Sciences, Aichi 470-1192, Japan; Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Sciences, Aichi 470-1192, Japan; Japanese Drug Organization of Appropriate Use and Research, Aichi 468-0069, Japan
| | - Hisayoshi Kubota
- Department of Regulatory Science, Fujita Health University Graduate School of Health Sciences, Aichi 470-1192, Japan
| | - Hsin-Jung Lee
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Man-Hsin Chang
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Chen-Yi Wu
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Daniel E Knutson
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Marko Mihovilovic
- Institute of Applied Synthetic Chemistry, TU Wien, 1060 Vienna, Austria
| | - James Cook
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Werner Sieghart
- Center for Brain Research, Department of Molecular Neurosciences, Medical University Vienna, 1090 Wien, Austria
| | - Toshitaka Nabeshima
- Advanced Diagnostic System Research Laboratory, Fujita Health University Graduate School of Health Sciences, Aichi 470-1192, Japan; Japanese Drug Organization of Appropriate Use and Research, Aichi 468-0069, Japan
| | - Lih-Chu Chiou
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.
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26
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de Filippis R, De Fazio P, Kane JM, Schoretsanitis G. Core clinical manifestations of clozapine-related DRESS syndrome: A network analysis. Schizophr Res 2022; 243:451-453. [PMID: 34364714 DOI: 10.1016/j.schres.2021.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro 88100, Italy; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro 88100, Italy
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
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27
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Robertson M, Bastiampillai T, Gupta A. Clozapine-associated pneumonia: Under-recognised morbidity and mortality risk. Aust N Z J Psychiatry 2022; 56:412. [PMID: 34231418 DOI: 10.1177/00048674211025707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Madeleine Robertson
- Department of Psychiatry, Mental Health Division, Southern Adelaide local Health Network, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Psychiatry, South Australain Health and Medical Research Institute, Adelaide, SA, Australia
| | - Arun Gupta
- Department of Psychiatry, Mental Health Division, Southern Adelaide local Health Network, Adelaide, SA, Australia
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28
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Han J, Shen M, Wan Q, Lv Z, Xiao L, Wang G. Risk factors for community-acquired pneumonia among inpatients with mental disorders in a tertiary general hospital. Front Psychiatry 2022; 13:941198. [PMID: 35935435 PMCID: PMC9354262 DOI: 10.3389/fpsyt.2022.941198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is an important cause of hospitalization and death in patients with mental disorders. It is critical to understand the risk factors of CAP and determine prevention strategies to reduce CAP. The aim of this study is to explore the characteristics of inpatients with mental disorders who have CAP and analyze the risk factors. METHODS This retrospective study included 16,934 inpatients with mental disorders who were admitted for the first time to a tertiary general hospital between January 2017 and July 2021 (excluding January 2020-May 2020). Risk factors for CAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for age, gender, and BMI. RESULTS The CAP rate of inpatients with mental disorders was 1.78%. Inpatients who had CAP had a significantly prolonged hospital stay, and were more often admitted to a closed ward or the ICU. After PSM, the multivariable analysis revealed that clozapine use (OR = 3.212, 95% CI = 1.744-5.915, P < 0.001), schizophrenia spectrum disorder (OR = 2.785, 95% CI = 1.684-4.607, P < 0.001), alcohol consumption (OR = 2.549, 95% CI = 1.586-4.096, P < 0.001), cardiovascular disease (OR = 2.299, 95% CI = 1.362-3.879, P = 0.002), Charlson comorbidity index (CCI) ≥ 3 (OR = 2.092, 95% CI = 1.342-3.260, P = 0.001), organic mental disorder (OR = 1.941, 95% CI = 1.194-3.156, P = 0.007), antipsychotic drug use (OR = 1.886, 95% CI = 1.312-2.711, P = 0.001), unmarried status (OR = 1.720, 95% CI = 1.164-2.541, P = 0.006) and junior high school education (OR = 1.591, 95%CI = 1.010-2.508, P = 0.045) were independent risk factors for CAP in inpatients with mental disorders. CONCLUSION CAP was common in inpatients with mental disorders. Patients with mental disorders have unique risk factors for CAP. Further research is required to explore the relationship and mechanism between different mental disorders, antipsychotic drugs and CAP.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Meiyu Shen
- Department of Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qirong Wan
- Department of Clinical Psychology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhihua Lv
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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29
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Sampogna G, Luciano M, Di Vincenzo M, Andriola I, D'Ambrosio E, Amore M, Serafini G, Rossi A, Carmassi C, Dell'Osso L, Di Lorenzo G, Siracusano A, Rossi R, Fiorillo A. The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study. Front Psychiatry 2022; 13:945650. [PMID: 35898630 PMCID: PMC9309609 DOI: 10.3389/fpsyt.2022.945650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2-3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771-0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Enrico D'Ambrosio
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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30
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de Leon J, Schoretsanitis G, Smith RL, Molden E, Solismaa A, Seppälä N, Kopeček M, Švancer P, Olmos I, Ricciardi C, Iglesias-Garcia C, Iglesias-Alonso A, Spina E, Ruan CJ, Wang CY, Wang G, Tang YL, Lin SK, Lane HY, Kim YS, Kim SH, Rajkumar AP, González-Esquivel DF, Jung-Cook H, Baptista T, Rohde C, Nielsen J, Verdoux H, Quiles C, Sanz EJ, Las Cuevas CD, Cohen D, Schulte PFJ, Ertuğrul A, Yağcıoğlu AEA, Chopra N, McCollum B, Shelton C, Cotes RO, Kaithi AR, Kane JM, Farooq S, Ng CH, Bilbily J, Hiemke C, López-Jaramillo C, McGrane I, Lana F, Eap CB, Arrojo-Romero M, Rădulescu FŞ, Seifritz E, Every-Palmer S, Bousman CA, Bebawi E, Bhattacharya R, Kelly DL, Otsuka Y, Lazary J, Torres R, Yecora A, Motuca M, Chan SKW, Zolezzi M, Ouanes S, Berardis DD, Grover S, Procyshyn RM, Adebayo RA, Kirilochev OO, Soloviev A, Fountoulakis KN, Wilkowska A, Cubała WJ, Ayub M, Silva A, Bonelli RM, Villagrán-Moreno JM, Crespo-Facorro B, Temmingh H, Decloedt E, Pedro MR, Takeuchi H, Tsukahara M, Gründer G, Sagud M, Celofiga A, Ristic DI, Ortiz BB, Elkis H, Pacheco Palha AJ, LLerena A, Fernandez-Egea E, Siskind D, Weizman A, Masmoudi R, Saffian SM, Leung JG, Buckley PF, Marder SR, Citrome L, Freudenreich O, Correll CU, Müller DJ. An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels. PHARMACOPSYCHIATRY 2021; 55:73-86. [PMID: 35052001 DOI: 10.1055/a-1625-6388] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA.,Department of Psychiatry, University of Kentucky, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA
| | - Robert L Smith
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.,Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Anssi Solismaa
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Tampere, Finland
| | | | - Miloslav Kopeček
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Patrik Švancer
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Ismael Olmos
- Clinical Pharmacology Unit and Pharmacy Department, Vilardebó Hospital, Administración de Servicios de Salud, Montevideo, Uruguay
| | - Carina Ricciardi
- Clinical Pharmacology Unit and Outpatient Clinic, Vilardebó Hospital, Administración de Servicios de Salud, Montevideo, Uruguay
| | - Celso Iglesias-Garcia
- Universidad de Oviedo. CIBERSAM. INEUROPA. ISPA-FIMBA, Oviedo, Spain.,Hospital Valle del Nalón, Langreo, Spain
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology, Beijing Anding Hospital, Capital Medical University, Beijing, China.,The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chuan-Yue Wang
- The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Substance Abuse Treatment Program, Atlanta VA Medical Center, Decatur, Georgia, USA
| | - Shih-Ku Lin
- Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Yong Sik Kim
- Department of Neuropsychiatry, Nowon Eulji Medical Center, Eulji University, School of Medicine, Seoul, Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Anto P Rajkumar
- Department of Psychiatry, Christian Medical College, Vellore, India.,Institute of Mental Health, Jubilee Campus, University of Nottingham, Triumph Road, Nottingham, United Kingdom
| | | | - Helgi Jung-Cook
- Instituto Nacional de Neurología y Neurocirugía, México City, México.,Facultad de Química, Universidad Nacional Autónoma de México (UNAM), México City, México
| | - Trino Baptista
- Department of Physiology, Los Andes University Medical School, Mérida, Venezuela
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jimmi Nielsen
- Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Clelia Quiles
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain.,Hospital Universitario de Canarias, Tenerife, Spain
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, Canary Islands, Spain
| | - Dan Cohen
- Dutch Clozapine Collaboration Group, Castricum, The Netherlands.,FACT-team in Heerhugowaard, Department of Severe Mental Illness, Mental Health Services North-Holland North, The Netherlands
| | - Peter F J Schulte
- Dutch Clozapine Collaboration Group, Castricum, The Netherlands.,Mental Health Team Alkmaar, Mental Health Services Noord-Holland-Noord, Alkmaar, The Netherlands
| | - Aygün Ertuğrul
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Nitin Chopra
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles Shelton
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA.,Eastern State Hospital, Lexington, Kentucky, USA
| | - Robert O Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, New York, USA
| | - Saeed Farooq
- School of Medicine, Keele University, Staffordshire, and Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Chee H Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Bilbily
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Germany
| | - Carlos López-Jaramillo
- Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia.,Programa Trastornos del Ánimo, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Ian McGrane
- Department of Pharmacy Practice, University of Montana, Missoula, USA
| | - Fernando Lana
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain.,Department of Psychiatry, Autonomous University of Barcelona, Spain
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland
| | - Manuel Arrojo-Romero
- Department of Psychiatry, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Flavian Ş Rădulescu
- Center for Drug Sciences, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Susanna Every-Palmer
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Chad A Bousman
- Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, and Community Health Sciences University of Calgary, Alberta, Canada
| | - Emmanuel Bebawi
- Faculty of Medicine, University of Montreal, Montreal, Canada.,Department of Pharmacy, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Rahul Bhattacharya
- East London NHS Foundation Trust, London, United Kingdom.,Honorary Clinical Senior Lecturer, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Deanna L Kelly
- Department of Psychiatry, School of Medicine, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuji Otsuka
- Department of Psychiatry, Asahi General Hospital, Chiba, Japan
| | - Judit Lazary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Rafael Torres
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Agustin Yecora
- Secretaría de Salud Mental y Adicciones, Ministerio de Salud de la Provincia de Jujuy, San Salvador de Jujuy, Argentina
| | - Mariano Motuca
- Instituto Vilapriño, Center for Studies, Assistance and Research in Neurosciences, Mendoza, Argentina
| | - Sherry K W Chan
- Department of Psychiatry, LSK Faculty of Medicine, The University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | | | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ric M Procyshyn
- British Columbia Mental Health and Substance Use Research Institute, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Oleg O Kirilochev
- Department of Clinical Pharmacology, Astrakhan State Medical University, Astrakhan, Russian Federation
| | - Andrey Soloviev
- Department of Psychiatry and Clinical Psychology, Northern State Medical University, Arkhangelsk, Russia
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland
| | - Wiesław J Cubała
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland
| | - Muhammad Ayub
- Department of Psychiatry, Queens University, Kingston, Canada
| | - Alzira Silva
- Psychiatry Department, Centro Hospitalar Universitário de S. João, Porto, Portugal., Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - José M Villagrán-Moreno
- Department of Neurosciences, Jerez University Hospital, Andalusian Health Service, University of Cadiz, Jerez, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBIS, Sevilla, Spain., Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Western Cape, Cape Town, South Africa
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Tsukahara
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marina Sagud
- Department of Psychiatry, School of Medicine, University of Zagreb, Zagreb, Croatia.,Department for Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Croatia
| | - Andreja Celofiga
- Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia
| | | | - Bruno B Ortiz
- Group of Resistant Schizophrenia (GER), Schizophrenia Program (Proesq), Federal University of Sao Paulo, SP, Brazil
| | - Helio Elkis
- Department and Institute of Psychiatry, University of São Paulo Medical School (FMUSP), Sao Paulo, Brazil
| | - António J Pacheco Palha
- Department and Institute of Psychiatry and Mental Health, Oporto Faculty of Medicine, Oporto, Portugal.,Casa de Salidedo Som Jesus (Psychiatric Hospital), Oporto, Portugal
| | - Adrián LLerena
- INUBE Biosanitary Research Institute of Extremadura. Extremadura University Hospital and Medical School, Badajoz, Spain.,Spanish Network for Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Emilio Fernandez-Egea
- Cambridge Psychosis Centre, Cambrigeshire and Peterborough NHS Foundation Trust & Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia.,Queensland Centre for Mental Health Research and School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Abraham Weizman
- Research Unit, Geha Mental Health Center and Molecular Psychiatry Laboratory, Felsenstein Medical Research Center, Tel Aviv, Israel.,Department of Psychiatry Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rim Masmoudi
- Psychiatry "A" Department, Hedi Chaker University Hospital, Sfax, Tunisia.,Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Peter F Buckley
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA.,VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Leslie Citrome
- New York Medical College, Department of Psychiatry and Behavioral Sciences, Valhalla, NY, USA
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hempstead, New York, USA.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Daniel J Müller
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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31
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Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry 2021; 20:52. [PMID: 34903254 PMCID: PMC8670051 DOI: 10.1186/s12991-021-00374-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10-25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced. MAIN TEXT Factors associated with the high mortality rates in patients with severe mental disorders can be grouped into four groups: those related to the patients, to psychiatrists, to other non-psychiatrist medical doctors and to the healthcare system. Each of these factors should become the target of specific and dedicated interventions, in order to reduce the morbidity and mortality rate in patients with severe mental disorders. All these elements contribute to the neglect of physical comorbidity in patients with severe mental. In particular, the long-standing separation of psychiatry from other branches of medicine and the lack of specific training on this issue further contribute to the poor attention dedicated to management of physical comorbidities. Recently, several professional associations have invited national bodies regulating education of healthcare professionals to include the management of physical health of people with severe mental disorders in undergraduate and postgraduate educational programs. CONCLUSIONS The premature mortality in patients with severe mental disorders is a complex phenomenon resulting by the interaction of several protective and risk factors. Therefore, a multilevel approach is needed, in which the different stakeholders involved in health care provision establish workforces for the long-term management of physical and mental health conditions.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L Vanvitelli", Naples, Italy.
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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32
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Javelot H, Straczek C, Meyer G, Gitahy Falcao Faria C, Weiner L, Drapier D, Fakra E, Fossati P, Weibel S, Dizet S, Langrée B, Masson M, Gaillard R, Leboyer M, Llorca PM, Hingray C, Haffen E, Yrondi A. Psychotropics and COVID-19: An analysis of safety and prophylaxis. L'ENCEPHALE 2021; 47:564-588. [PMID: 34548153 PMCID: PMC8410507 DOI: 10.1016/j.encep.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022]
Abstract
The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.
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Affiliation(s)
- H Javelot
- Établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, centre de recherche en biomédecine de Strasbourg, université de Strasbourg, 1, rue Eugène-Boeckel, 67000 Strasbourg, France.
| | - C Straczek
- Département de pharmacie, CHU d'Henri-Mondor, université Paris Est Créteil (UPEC), AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France; Inserm U955, institut Mondor de recherche biomédical, neuropsychiatrie translationnelle, 8, rue du Général-Sarrail, 94000 Créteil, France
| | - G Meyer
- Service pharmacie, établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Service pharmacie, CHU de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - C Gitahy Falcao Faria
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), avenue Pedro-Calmon, 550 - Cidade Universitária da Universidade Federal do Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil
| | - L Weiner
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, 2, avenue du Professeur Léon-Bernard, CS 34317, campus santé de Villejean, 35043 Rennes cedex, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, 37, rue Michelet, 42000 Saint-Étienne, France
| | - P Fossati
- Inserm U1127, ICM, service de psychiatrie adultes, groupe hospitalier pitié Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Weibel
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - S Dizet
- Centre de ressources et d'expertise en psychopharmacologie (CREPP) Bourgogne Franche-Comté, Chalon-sur-Saône, France; Service Pharmacie, CHS de Sevrey, 55, rue Auguste-Champio, 71100 Sevrey, France
| | - B Langrée
- Service pharmacie, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; Clinique du Château de Garches, Nightingale Hospitals-Paris, 11, bis rue de la Porte-Jaune, 92380 Garches, France
| | - M Masson
- SHU, GHU psychiatrie et neurosciences, 1, rue Cabanis, 75014 Paris, France; GHU psychiatrie et neurosciences, université de Paris, Paris, France
| | - R Gaillard
- Conseil national des universités (CNU), 1, rue Cabanis, 75014 Paris, France
| | - M Leboyer
- Inserm, DMU IMPACT, IMRB, translational neuropsychiatry, fondation FondaMental, hôpitaux universitaires « H. Mondor », université Paris Est Créteil (UPEC), AP-HP, 40, rue de Mesly, 94000 Créteil, France; CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P M Llorca
- Université Clermont-Auvergne, 1, rue Lucie- et Raymond-Aubrac, 63100 Clermont-Ferrand, France; Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, 1, rue Docteur Archambault, 54520 Laxou, France
| | - C Hingray
- Département de neurologie, CHU de Nancy, 25, rue Lionnois, 54000 Nancy, France; CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - E Haffen
- Laboratoire de neurosciences, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - A Yrondi
- Unité ToNIC, UMR 1214 CHU Purpan-Pavillon Baudot, place du Dr Joseph Baylac, 31024 Toulouse cedex 3, France
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33
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Lahiff D, Chatham P, Sullivan G, Fusick AJ. Clozapine and COVID-19: A Case Report and Clinical Considerations. Curr Drug Saf 2021; 17:382-386. [PMID: 34847849 DOI: 10.2174/1574886316666211130142624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The emergence of coronavirus SARS-CoV-2, and the subsequent global epidemic of COVID-19, brought with it innumerable new clinical experiences across all medical specialties, and psychiatry is no exception. Individuals with serious mental illness, in particular schizophrenia and related disorders, may be especially susceptible to coronavirus infection given the overlapping risk factors of vulnerable sociodemographic status, increased challenges with quarantining requirements, and limited compliance with "respiratory etiquette." The case presented here describes a patient with schizophrenia who was being managed on clozapine and who developed symptomatic COVID-19 infection. Special care was taken to ensure that potential interactions between clozapine and the associated COVID-19 treatments were safe for the patient's mental and physical wellbeing. CASE PRESENTATION A 71-year-old schizophrenic Caucasian male is being managed with clozapine. While hospitalized, the patient was screened positive for COVID-19 and was admitted to the ICU due to his declining respiratory status. He was treated with both remdesivir and prednisone. He was able to fully recover from his COVID-19 infection. CONCLUSION The authors review the clinical characteristics of the case, highlighting both the overlapping synergistic effects and antagonistic influences of clozapine therapy in combination with COVID-19 and its associated treatments. A review of the literature offers an opportunity to examine various frameworks for individualized clinical decision-making while making the case for greater epidemiologic research into the optimal management of individuals with a psychotic disorder who are diagnosed with COVID-19 infection.
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Affiliation(s)
- Dylan Lahiff
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida. United States
| | - Peggy Chatham
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida. United States
| | - Gregory Sullivan
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida. United States
| | - Adam J Fusick
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida. United States
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34
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Effects of an Atypical Antipsychotic, Zotepine, on Astroglial L-Glutamate Release through Hemichannels: Exploring the Mechanism of Mood-Stabilising Antipsychotic Actions and Antipsychotic-Induced Convulsion. Pharmaceuticals (Basel) 2021; 14:ph14111116. [PMID: 34832898 PMCID: PMC8625878 DOI: 10.3390/ph14111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 02/06/2023] Open
Abstract
Accumulating neuropsychopharmacological evidence has suggested that functional abnormalities of astroglial transmission and protein kinase B (Akt) contribute to the pathophysiology and/or pathomechanisms of several neuropsychiatric disorders, such as epilepsy, schizophrenia, affective disorders and antipsychotic-induced convulsions. Therefore, to explore the pathophysiology of mood-stabilising antipsychotics and the proconvulsive actions of atypical antipsychotics, the present study determined the effects of a mood-stabilising, atypical, antipsychotic agent, zotepine (ZTP), on astroglial L-glutamate release and the expression of connexin43 (Cx43) protein in cortical, primary, cultured astrocytes using ultra-high-pressure liquid chromatography and capillary immunoblotting systems. Both acute and subchronic administrations of therapeutically relevant concentrations of ZTP did not affect astroglial L-glutamate release or Cx43 expression in plasma membranes; however, chronic administration of a therapeutically relevant concentration of ZTP increased astroglial L-glutamate release and Cx43 expression in the plasma membrane. Subchronic administrations of a supratherapeutic concentration of ZTP enhanced astroglial L-glutamate release and Cx43 expression in the plasma membrane, whereas acute administration of a supratherapeutic concentration of ZTP enhanced astroglial L-glutamate release without affecting Cx43 expression. These stimulatory effects of ZTP on astroglial L-glutamate release through activated hemichannels and Cx43 trafficking to the astroglial plasma membrane were suppressed by the Akt inhibitor. These results suggest that ZTP enhances astroglial L-glutamate release in a concentration-dependent and time-dependent manner due to the enhanced function of astroglial hemichannels, probably via activation of Akt signalling. Therefore, the enhanced astroglial L-glutamatergic transmission induced by ZTP is, at least partially, involved in the mood-stabilising antipsychotic and proconvulsive actions of ZTP.
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35
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Wagner E, Siafis S, Fernando P, Falkai P, Honer WG, Röh A, Siskind D, Leucht S, Hasan A. Efficacy and safety of clozapine in psychotic disorders-a systematic quantitative meta-review. Transl Psychiatry 2021; 11:487. [PMID: 34552059 PMCID: PMC8458455 DOI: 10.1038/s41398-021-01613-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 02/08/2023] Open
Abstract
A recent increase in the literature regarding the evidence base for clozapine has made it increasingly difficult for clinicians to judge "best evidence" for clozapine use. As such, we aimed at elucidating the state-of-the-art for clozapine with regard to efficacy, effectiveness, tolerability, and management of clozapine and clozapine-related adverse events in neuropsychiatric disorders. We conducted a systematic PRISMA-conforming quantitative meta-review of available meta-analytic evidence regarding clozapine use. Primary outcome effect sizes were extracted and transformed into relative risk ratios (RR) and standardized mean differences (SMD). The methodological quality of meta-analyses was assessed using the AMSTAR-2 checklist. Of the 112 meta-analyses included in our review, 61 (54.5%) had an overall high methodological quality according to AMSTAR-2. Clozapine appears to have superior effects on positive, negative, and overall symptoms and relapse rates in schizophrenia (treatment-resistant and non-treatment-resistant subpopulations) compared to first-generation antipsychotics (FGAs) and to pooled FGAs/second-generation antipsychotics (SGAs) in treatment-resistant schizophrenia (TRS). Despite an unfavorable metabolic and hematological adverse-event profile compared to other antipsychotics, hospitalization, mortality and all-cause discontinuation (ACD) rates of clozapine surprisingly show a pattern of superiority. Our meta-review outlines the superior overall efficacy of clozapine compared to FGAs and most other SGAs in schizophrenia and suggests beneficial efficacy outcomes in bipolar disorder and Parkinson's disease psychosis (PDP). More clinical studies and subsequent meta-analyses are needed beyond the application of clozapine in schizophrenia-spectrum disorders and future studies should be directed into multidimensional clozapine side-effect management to foster evidence and to inform future guidelines.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Spyridon Siafis
- grid.15474.330000 0004 0477 2438Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Piyumi Fernando
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - William G. Honer
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, The University of British Columbia, Vancouver, Canada
| | - Astrid Röh
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Dan Siskind
- grid.1003.20000 0000 9320 7537School of Medicine, University of Queensland, Brisbane, Australia ,Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Stefan Leucht
- grid.15474.330000 0004 0477 2438Department of Psychiatry and Psychotherapy, School of Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Alkomiet Hasan
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
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Bonnet U, Claus B, Schaefer M, Kuhn J, Nyhuis P, Scherbaum N, Brüne M, Wakili V, Juckel G. Impact of Psychiatric and Related Somatic Medications on the Duration and Severity of COVID-19: A Retrospective Explorative Multi-center Study from the German Metropolitan Ruhr-area. PHARMACOPSYCHIATRY 2021; 55:30-39. [PMID: 34530483 DOI: 10.1055/a-1559-3904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Several psychiatric and somatic medications are assumed to improve COVID-19-symptoms. These include antidepressants, antipsychotics, and anticonvulsants as well as anticoagulants, statins, and renin-angiotensin-aldosterone-system (RAAS)-inhibitors for somatic comorbid conditions. All these agents may reduce the hyperinflammatory response to SARS/CoV-2 or the related negative cardio-cerebrovascular outcomes. METHODS In a retrospective longitudinal, multi-center inpatient study, we sought to explore the influence of psychiatric medications on COVID-19, comprising the period from diagnosing SARS/CoV-2-infection via PCR (nasopharyngeal swab) up to the next 21 days. Ninety-six psychiatric inpatients (mean age [SD] 65.5 (20.1), 54% females) were included. The primary outcome was the COVID-19-duration. Secondary outcomes included symptom severity and the presence of residual symptoms. RESULTS COVID-19-related symptoms emerged in 60 (62.5%) patients, lasting 6.5 days on average. Six (6.3%) 56-95 years old patients died from or with COVID-19. COVID-19-duration and residual symptom-presence (n=22, 18%) were not significantly related to any substance. Respiratory and neuro-psychiatric symptom-load was significantly and negatively related to prescription of antidepressants and anticoagulants, respectively. Fatigue was negatively and positively related to RAAS-inhibitors and proton-pump-inhibitors, respectively. These significant relationships disappeared with p-value adjustment owed to multiple testing. The mean total psychiatric burden was not worsened across the study. DISCUSSION None of the tested medications was significantly associated with the COVID-19-duration and -severity up to the end of post-diagnosing week 3. However, there were a few biologically plausible and promising relationships with antidepressants, anticoagulants, and RAAS-inhibitors before p-value adjustment. These should encourage larger and prospective studies to re-evaluate the influence of somatic and psychiatric routine medications on COVID-19-related health outcomes.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.,LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - BenediktBernd Claus
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany.,PedScience, Datteln, Germany
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychoso-matics and Addiction Medicine, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Martin Brüne
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Velat Wakili
- Department of Psychiatry, Psychotherapy, Psychoso-matics and Addiction Medicine, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
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Hata M, Fujimoto M, Kanai K, Yoshiyama K, Nakatani Y, Nakabayashi D, Maemura S, Kawata S, Hakozaki T, Nishikura S, Umemoto A, Sasada T, Iwata K, Tanaka H, Mamoto A, Toi Y, Taniguchi N, Saito M, Kimura Y, Kishimoto K, Hayami M, Ikeda M. No adverse events were observed in clozapine-treated patients on extended hematologic monitoring intervals during the coronavirus pandemic in four psychiatric centers in Japan. Neuropsychopharmacol Rep 2021; 41:179-184. [PMID: 33606356 PMCID: PMC8013689 DOI: 10.1002/npr2.12166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/04/2021] [Accepted: 02/04/2021] [Indexed: 01/23/2023] Open
Abstract
AIM As an emergency measure during the coronavirus disease pandemic, the monitoring interval for clozapine use was temporarily extended beyond the regulatory requirement in Japan, which is the safest monitoring interval worldwide. In this study, we aimed to explore the effect of this measure on patients undergoing clozapine treatment. METHODS This retrospective chart review study included patients with treatment-resistant schizophrenia (TRS) who were undergoing clozapine treatment at four psychiatric institutions in Japan. Demographic characteristics and clinical information of these patients were collected on April 27, 2020, when Japanese psychiatrists were virtually allowed to prescribe clozapine beyond the regulatory requirement. Furthermore, information of adverse events related to the emergency measure was collected and analyzed. RESULTS Of the 41 patients with TRS included in this study, 19 patients underwent extended hematological monitoring during clozapine treatment. No psychiatric or hematological adverse events were observed in the patients during the extended monitoring interval. CONCLUSION This study suggested that there were few adverse events of clozapine-treated patients related to emergency measures in Japan. However, hematological monitoring intervals during clozapine treatment have been emergently extended worldwide; hence, it is necessary to verify the results of these measures.
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Affiliation(s)
- Masahiro Hata
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
| | - Michiko Fujimoto
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
| | - Koji Kanai
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
| | - Kenji Yoshiyama
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
| | - Yoshitaka Nakatani
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
- Osaka Psychiatric Medical CenterOsakaJapan
| | | | | | | | | | | | | | | | | | | | | | - Yuuki Toi
- Asakayama General HospitalOsakaJapan
| | | | | | | | | | | | - Manabu Ikeda
- Department of PsychiatryOsaka University Graduate School of MedicineSuitaJapan
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de Leon J, De Las Cuevas C, Sanz EJ, Verdoux H. The association of clozapine and haematological malignancies needs to be replicated by other studies and more importantly by analyses of subsamples from VigiBase. Psychol Med 2021; 51:1405-1406. [PMID: 32372739 DOI: 10.1017/s0033291720001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
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39
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Chrétien B, Lelong-Boulouard V, Alexandre J, Fedrizzi S, Dolladille C. Response to 'The association of clozapine and haematological malignancies needs to be replicated by other studies and more importantly by analyses of subsamples from VigiBase'. Psychol Med 2021; 51:1407-1408. [PMID: 32635951 DOI: 10.1017/s0033291720002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, UFR Santé, INSERM UMR 1075, COMETE-MOBILITES 'Vieillissement, Pathologie, Santé', 14000Caen, France
| | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Pharmacovigilance Regional Center, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, F-14000, France
- Normandie Univ, UNICAEN, EA4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000Caen, France
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40
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Cepaityte D, Siafis S, Egberts T, Leucht S, Kouvelas D, Papazisis G. Exploring a Safety Signal of Antipsychotic-Associated Pneumonia: A Pharmacovigilance-Pharmacodynamic Study. Schizophr Bull 2021; 47:672-681. [PMID: 33289848 PMCID: PMC8084433 DOI: 10.1093/schbul/sbaa163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An association between antipsychotic drugs and pneumonia has been demonstrated in several studies; however, the risk for pneumonia caused by specific antipsychotics has not been extensively studied. The underlying mechanism is still unknown, and several receptor mechanisms have been proposed. Therefore, using a combined pharmacovigilance-pharmacodynamic approach, we aimed to investigate safety signals of US Food and Drug Administration (FDA)-approved antipsychotics for reporting pneumonia and the potential receptor mechanisms involved. A disproportionality analysis was performed to detect a signal for reporting "infective-pneumonia" and "pneumonia-aspiration" and antipsychotics using reports submitted between 2004 and 2019 to the FDA adverse events spontaneous reporting system (FAERS) database. Disproportionality was estimated using the crude and the adjusted reporting odds ratio (aROR) and its 95% confidence interval (CI) in a multivariable logistic regression. Linear regressions investigated the relationship between aROR and receptor occupancy, which was estimated using in vitro receptor-binding profiles. Safety signals for reporting infective-pneumonia were identified for clozapine (LL = 95% 3.4, n = 546 [aROR: 4.8]) as well as olanzapine (LL = 95% 1.5, n = 250 [aROR: 2.1]) compared with haloperidol, while aRORs were associated with higher occupancies of muscarinic receptors (beta = .125, P-value = .016), yet other anti-muscarinic drugs were not included as potential confounders. No safety signals for reporting pneumonia-aspiration were detected for individual antipsychotics. Multiple antipsychotic use was associated with both reporting infective-pneumonia (LL 95%: 1.1, n = 369 [aROR:1.2]) and pneumonia-aspiration (LL 95%: 1.7, n = 194 [aROR: 2.0]). Considering the limitations of disproportionality analysis, further pharmacovigilance data and clinical causality assessment are needed to validate this safety signal.
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Affiliation(s)
- Dainora Cepaityte
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Toine Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Division of Pharmacoepidemiology and Clinical Pharmacology, The Netherlands & Utrecht Institute of Pharmaceutical Science, Faculty of Science, Utrecht University, The Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Suhas S, Kumar V, Damodharan D, Sharma P, Rao NP, Varambally S, Venkatasubramanian G, Murthy P, Gangadhar BN. Comment on: "Elevated Clozapine Concentrations in Clozapine-Treated Patients with Hypersalivation". Clin Pharmacokinet 2021; 60:1073-1075. [PMID: 33899164 DOI: 10.1007/s40262-021-01021-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Satish Suhas
- Schizophrenia and Metabolic Clinics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Vijay Kumar
- Schizophrenia and Metabolic Clinics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India.
| | - Dinakaran Damodharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Priyamvada Sharma
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Naren P Rao
- Schizophrenia and Metabolic Clinics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Shivarama Varambally
- Schizophrenia and Metabolic Clinics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Ganesan Venkatasubramanian
- Schizophrenia and Metabolic Clinics, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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42
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Verdoux H, Debruyne AL, Queuille E, De Leon J. A reappraisal of the role of fever in the occurrence of neurological sequelae following lithium intoxication: a systematic review. Expert Opin Drug Saf 2021; 20:827-838. [PMID: 33789560 DOI: 10.1080/14740338.2021.1912011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We aimed to review cases of Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) characterized by neurological sequelae following acute lithium toxicity and to explore whether cerebellar sequelae are more frequent in cases presenting with fever and/or infection. AREAS COVERED Case reports were identified from: (i) 6 reviews published up to 2005; (ii) MEDLINE, Web of Sciences, Cochrane Library and PsycINFO search. EXPERT OPINION We identified 123 SILENT cases published from 1965 to 2019, in which cerebellar sequelae were observed in an overwhelming proportion (79%). SILENT may occur at any time during lithium treatment. This complication is most frequently observed during routine lithium treatment, with fewer than 10% of cases occurring after accidental or intentional overdoses. SILENT may occur even when lithium plasma levels are within the therapeutic range: 63% of cases had lithium plasma level <2.5 mEq/l (low/mild toxicity). Fever and/or infection were reported in nearly half of the patients (48%). The likelihood of presenting with cerebellar vs. other neurological sequelae was independently increased by elevated plasma lithium level (≥ 2.5 mEq/l) and by a history of fever and/or infection. Lithium users should be warned of the need to consult in case of fever to adjust their lithium dosage.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | | | | | - Jose De Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY and Psychiatry and Neurosciences Research Group (CTS-549), USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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43
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SCHIZOPHRENIA in the midst of a COVID-19 outbreak in a psychiatric hospital in COLOMBIA. Psychiatry Res 2021; 298:113785. [PMID: 33582523 PMCID: PMC7866840 DOI: 10.1016/j.psychres.2021.113785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
Herein, the characteristics of a group of hospitalized schizophrenic patients diagnosed with SARS Cov-2 are reported. The total number of COVID-19 positive schizophrenic patients at the time of this investigation was 46. During an internal outbreak in the clinic, all inpatients were diagnosed via PCR tests. Half the patients showed no symptoms of COVID-19, 22 (47.8%) patients suffered from associated diseases including hypertension and dyslipidemia, four patients had to be transferred to a General Hospital for pneumonia treatment, and none of the patients required ICU treatment. All patients recovered. Twenty of the patients were on clozapine as antipsychotic treatment.
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Schoretsanitis G, Ruan CJ, Rohde C, Verdoux H, De Las Cuevas C, Spina E, de Leon J. An update on the complex relationship between clozapine and pneumonia. Expert Rev Clin Pharmacol 2021; 14:145-149. [PMID: 33461363 DOI: 10.1080/17512433.2021.1877135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hélène Verdoux
- Team Pharmacoepidemiology, University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of la Laguna, Canary Islands, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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45
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Clinically Relevant Interactions between Atypical Antipsychotics and Anti-Infective Agents. Pharmaceuticals (Basel) 2020; 13:ph13120439. [PMID: 33276675 PMCID: PMC7761579 DOI: 10.3390/ph13120439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
This is a comprehensive review of the literature on drug interactions (DIs) between atypical antipsychotics and anti-infective agents that focuses on those DIs with the potential to be clinically relevant and classifies them as pharmacokinetic (PK) or pharmacodynamic (PD) DIs. PubMed searches were conducted for each of the atypical antipsychotics and most commonly used anti-infective agents (13 atypical antipsychotics by 61 anti-infective agents/classes leading to 793 individual searches). Additional relevant articles were obtained from citations and from prior review articles written by the authors. Based on prior DI articles and our current understanding of PK and PD mechanism, we developed tables with practical recommendations for clinicians for: antibiotic DIs, antitubercular DIs, antifungal DIs, antiviral DIs, and other anti-infective DIs. Another table reflects that in clinical practice, DIs between atypical antipsychotics and anti-infective agents occur in patients also suffering an infection that may also influence the PK and PD mechanisms of both drugs (the atypical antipsychotic and the anti-infective agent(s)). These tables reflect the currently available literature and our current knowledge of the field and will need to be updated as new DI information becomes available.
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46
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Ostuzzi G, Papola D, Gastaldon C, Schoretsanitis G, Bertolini F, Amaddeo F, Cuomo A, Emsley R, Fagiolini A, Imperadore G, Kishimoto T, Michencigh G, Nosé M, Purgato M, Serdar D, Stubbs B, Taylor D, Thornicroft G, Ward PB, Hiemke C, Correll CU, Barbui C. Safety of Psychotropic Medications in People With COVID-19: Evidence Review and Practical Recommendations. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:466-481. [PMID: 33343260 DOI: 10.1176/appi.focus.18308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from the BMC Medicine (2020) 18:215).
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47
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Schoretsanitis G, Kuzin M, Kane JM, Hiemke C, Paulzen M, Haen E. Elevated Clozapine Concentrations in Clozapine-Treated Patients with Hypersalivation. Clin Pharmacokinet 2020; 60:329-335. [PMID: 33000411 DOI: 10.1007/s40262-020-00944-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypersalivation is a common, clozapine-related adverse drug reaction with a serious impact on quality of life. Pharmacokinetic correlates of clozapine-related hypersalivation have evaded attention. The purpose of this study was to compare pharmacokinetic parameters between clozapine-treated patients with vs. without hypersalivation from a large therapeutic drug monitoring database. METHODS Out of a large therapeutic drug monitoring dataset of clozapine-treated patients, we compared a group of patients with hypersalivation (n = 72) and a control group of patients without any adverse reactions in this regard (n = 323). Comparisons included plasma concentrations and concentrations-by-dose as well as demographic characteristics between groups. Post-hoc analyses were performed separately in smokers and non-smokers. We used the non-parametric Mann-Whitney U test and the chi-square test, while effects of confounders were assessed using a bootstrapping analysis of covariance. RESULTS Patients with hypersalivation had higher clozapine plasma concentrations and concentrations-by-dose (p < 0.001 for the Mann-Whitney U test in both cases). Groups did not differ regarding demographic characteristics except for clozapine daily dose and percentage of smokers (p = 0.005 for the Mann-Whitney U test and p = 0.028 for the chi-square test, respectively). There were fewer smokers across patients with hypersalivation compared with patients without and daily doses were higher in patients with hypersalivation. After analysis of covariance, differences remained for both plasma concentrations and concentrations-by-dose (p < 0.001 for both). Post hoc analyses in smokers and non-smokers separately reported similar findings. CONCLUSIONS Elevated clozapine plasma concentrations and higher concentrations-by-dose were observed in patients with hypersalivation. A potential role for therapeutic drug monitoring in the prevention or management of clozapine-related hypersalivation is suggested.
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Affiliation(s)
- Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.
| | - Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil Am See, Zurich, Switzerland
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Behavioral Health Pavilion, 7559 263rd Street, Glen Oaks, NY, 11004, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christoph Hiemke
- Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany
| | - Michael Paulzen
- Alexianer Hospital Aachen, Alexianergraben 33, 52062, Aachen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.,JARA, Translational Brain Medicine, Jülich, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, Clinical Pharmacology, University of Regensburg, Regensburg, Germany.,Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
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48
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Okada M, Fukuyama K, Shiroyama T, Murata M. A Working Hypothesis Regarding Identical Pathomechanisms between Clinical Efficacy and Adverse Reaction of Clozapine via the Activation of Connexin43. Int J Mol Sci 2020; 21:ijms21197019. [PMID: 32987640 PMCID: PMC7583770 DOI: 10.3390/ijms21197019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Clozapine (CLZ) is an approved antipsychotic agent for the medication of treatment-resistant schizophrenia but is also well known as one of the most toxic antipsychotics. Recently, the World Health Organization’s (WHO) global database (VigiBase) reported the relative lethality of severe adverse reactions of CLZ. Agranulocytosis is the most famous adverse CLZ reaction but is of lesser lethality compared with the other adverse drug reactions of CLZ. Unexpectedly, VigiBase indicated that the prevalence and relative lethality of pneumonia, cardiotoxicity, and seizures associated with CLZ were more serious than that of agranulocytosis. Therefore, haematological monitoring in CLZ patients monitoring system provided success in the prevention of lethal adverse events from CLZ-induced agranulocytosis. Hereafter, psychiatrists must amend the CLZ patients monitoring system to protect patients with treatment-resistant schizophrenia from severe adverse CLZ reactions, such as pneumonia, cardiotoxicity, and seizures, according to the clinical evidence and pathophysiology. In this review, we discuss the mechanisms of clinical efficacy and the adverse reactions of CLZ based on the accumulating pharmacodynamic findings of CLZ, including tripartite synaptic transmission, and we propose suggestions for amending the monitoring and medication of adverse CLZ reactions associated with pneumonia, cardiotoxicity, and seizures.
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Affiliation(s)
- Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (T.S.)
- Correspondence: ; Tel.: +81-59-231-5018
| | - Kouji Fukuyama
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (T.S.)
| | - Takashi Shiroyama
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; (K.F.); (T.S.)
| | - Masahiko Murata
- National Hospital Organization Sakakibara Hospital, 777 Sakakibara, Tsu, Mie 514-1292, Japan;
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Barnes TRE, MacCabe JH, Kane JM, Delgado O, Paton C. The physical health and side-effect monitoring of patients prescribed clozapine: data from a clinical audit conducted in UK mental health services. Ther Adv Psychopharmacol 2020; 10:2045125320937908. [PMID: 32821377 PMCID: PMC7412922 DOI: 10.1177/2045125320937908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In addition to mandatory haematological monitoring, treatment guidelines recommend routine monitoring of adverse effects and physical health in patients prescribed clozapine. METHODS NHS trusts/healthcare organisations participated in a clinical audit in the context of a UK quality improvement programme addressing clozapine-prescribing practice. RESULTS Data relating to 6948 adult patients prescribed clozapine were submitted by 63 NHS trusts/healthcare organisations. Of 481 patients treated with clozapine for up to 18 weeks, there was documented pretreatment screening of blood pressure, heart rate and ECG in at least 90%, and body weight, plasma lipids, plasma glucose/glycated haemoglobin (HbA1c) and physical examination in approximately 80%. During the first 2 weeks of clozapine treatment there was documented daily measurement of both heart rate and blood pressure in 82% and body temperature in 77%. In a subsample of 411 patients, of the 72% who had weekly side-effect assessments documented in the first month of treatment, a structured assessment tool had been used in 29%. Treatment monitoring up to 18 weeks included an ECG in 90%, C-reactive protein (CRP) or creatine kinase in 42%, and troponin or B-type natriuretic peptide (BNP) in 29%. In the 5908 patients prescribed clozapine for at least 1 year, blood pressure and body weight/body mass index were documented in at least 80%, plasma lipids in 78% and plasma glucose in 73%, with an ECG in 55%. Two-thirds were prescribed medication to manage side effects of clozapine and one third of those with a diagnosis of schizophrenia were prescribed a second antipsychotic medication. CONCLUSION The findings suggest that for most patients treated with clozapine in UK mental health services, physical health screening and side-effect monitoring follow recommended practice, but there was limited use of structured side-effect assessment tools. Monitoring for clozapine-induced myocarditis during the early risk period using markers of inflammation such as CRP, and cardiac damage such as troponin and BNP, was less consistent. This may partly reflect the variation in guideline recommendations for monitoring for myocarditis and partly the selected use of such tests when prompted by cardiac symptoms. The relatively common coprescription of medications for the majority of people on longer-term clozapine treatment may well further increase side-effect burden and physical health risks, reinforcing the need for continuing systematic monitoring.
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Affiliation(s)
- Thomas R. E. Barnes
- Division of Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - James H. MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK, NIHR Biomedical Research Centre for Mental Health, South London, UK, and Maudsley NHS Foundation Trust, London, UK
| | - John M. Kane
- Department of Psychiatry, Zucker Hillside Hospital, New York, USA
| | - Oriana Delgado
- Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Carol Paton
- Division of Psychiatry, Imperial College London, UK, and Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
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Affiliation(s)
- P F J Schulte
- Mental Health Service Noord-Holland-Noord, Heerhugowaard, The Netherlands.,Dutch Clozapine Collaboration Group, Alkmaar, The Netherlands
| | - J Bogers
- Dutch Clozapine Collaboration Group, Alkmaar, The Netherlands.,Mental Health Service Rivierduinen, Leiden, The Netherlands
| | - S R T Bond-Veerman
- Mental Health Service Noord-Holland-Noord, Heerhugowaard, The Netherlands.,Dutch Clozapine Collaboration Group, Alkmaar, The Netherlands
| | - D Cohen
- Mental Health Service Noord-Holland-Noord, Heerhugowaard, The Netherlands.,Dutch Clozapine Collaboration Group, Alkmaar, The Netherlands
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