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Zhou Y, Chen S, Wang Y, Liang J, Li H, Shi H, Miao T, Wu S, Xiao A, Ye J, Zheng X. Seasonal characteristics of nosocomial infection in a psychiatric hospital in China with different nosocomial prevention and control backgrounds: a retrospective study. Sci Rep 2024; 14:17045. [PMID: 39048616 PMCID: PMC11269690 DOI: 10.1038/s41598-024-65368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to investigate the relationship between various prevention and control measures for nosocomial infections (NIs) in psychiatric hospitals and patients with mental disorders. This study aimed to determine the characteristics of NIs in psychiatric hospitals and provide a reference for infection prevention and control in this setting. Data from the NI monitoring system of a psychiatric hospital in southeastern China were analysed. Patients who were hospitalized for mental disorders from January 1, 2016, to November 30, 2019, were classified into the non-COVID-19 containment group (NC19C group, n = 898), while those who were hospitalized from January 25, 2020, to November 30, 2022, were classified into the COVID-19 containment group (C19C group, n = 840). The data were analysed using SPSS version 22.0, and independent sample t tests, chi-square tests, correlation analyses, and multivariate logistic regression analyses were performed. A significance level of P < 0.0024 was applied. The incidence rate of NIs was higher in autumn in the NC19C group, while no seasonal difference was detected in the C19C group (P < 0.0024). Further analysis revealed that in the C19C group, the risk of hospitalized patients with mental disorders developing hospital-acquired pneumonia in spring was 0.362 times that in winter (OR = 0.362, 95% CI = 0.200 ~ 0.656, P = 0.001), and in summer, the risk was 0.342 times that in winter (OR = 0.342, 95% CI = 0.185 ~ 0.633 P = 0.001). Patients aged 18-44 years had a 4.260 times higher risk of developing hospital-acquired upper respiratory tract infections than did those aged 60 years and older (OR = 4.260, 95% CI = 2.143 ~ 8.470; P = 0.000). The risk of acquiring urinary tract infections in the hospital was 0.324 times greater among patients aged 18-44 years than for patients aged 60 years and older (OR = 0.324, 95% CI = 0.171-0.613; P = 0.001). The NC19C group did not exhibit the aforementioned differences. During the NC19C period, differences were observed in the diagnosis of hospital-acquired infections and sex (all P = 0.000). Psychiatric hospitals exhibit distinct nosocomial infection characteristics under the context of various infection control measures. Against the backdrop of strengthened infection control, the nosocomial infection characteristics of psychiatric hospitals may be associated with the features of mental disorders.
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Affiliation(s)
- Yufang Zhou
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Shuili Chen
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Youtian Wang
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Jingyu Liang
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huaijie Li
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Haishan Shi
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Tianyang Miao
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Shengwei Wu
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Aixiang Xiao
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Junrong Ye
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing Zheng
- The Affiliated Brain Hospital, Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, 510370, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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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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Kang N, Kim SH, Kim J, Kim S, Jang J, Yoon H, Lee J, Kim M, Kim YS, Kwon JS. Association between initial clozapine titration and pneumonia risk among patients with schizophrenia in a Korean tertiary hospital. Schizophr Res 2024; 268:107-113. [PMID: 37770376 DOI: 10.1016/j.schres.2023.09.029] [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: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
Pneumonia is a significant adverse drug reaction (ADR) associated with clozapine, characterized by high mortality and potential linkage with other inflammatory responses. Despite the critical nature, research regarding the development of pneumonia during initial clozapine titration remains limited. This retrospective study included 1408 Korean inpatients with schizophrenia spectrum disorders. Data were collected from January 2000 to January 2023. Pneumonia developed in 3.5 % of patients within 8 weeks of clozapine initiation. Patients who developed pneumonia were taking a greater number and higher dose of antipsychotics at baseline (2.14 vs. 1.58, p < 0.001; 25.64 vs. 19.34, p = 0.012). The average onset occurred 17.24 days after initiation, on an average dose of 151.28 mg/day. Titration was either paused or slowed in most of these patients, with no reported fatalities. The types of pneumonia included aspiration pneumonia, mycoplasma pneumonia, bronchopneumonia, and COVID-19 pneumonia. Myocarditis, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, and urinary tract infections were also identified. Logistic regression analysis revealed that a greater number of concomitant antipsychotics (odds ratio [OR] = 1.59, p = 0.027) and concomitant benzodiazepine use (OR = 2.33, p = 0.005) at baseline were associated with an increased risk of pneumonia. Overall, pneumonia development during clozapine titration is linked with other inflammatory ADRs, suggesting a shared immunological mechanism. Close monitoring is recommended, especially for patients taking multiple antipsychotics and benzodiazepines. Further studies involving repeated measures of clozapine concentrations at trough and steady state, along with a more detailed description of pneumonia types, are warranted.
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Affiliation(s)
- Nuree Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinhyeok Jang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesoo Yoon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeonghoon Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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He W, Wang Y, Chen K. A real-world pharmacovigilance study of FDA adverse event reporting system events for diazepam. Front Pharmacol 2024; 15:1278442. [PMID: 38327980 PMCID: PMC10847318 DOI: 10.3389/fphar.2024.1278442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background: Diazepam, one of the benzodiazepines, is widely used clinically to treat anxiety, for termination of epilepsy, and for sedation. However, the reports of its adverse events (AEs) have been numerous, and even fatal complications have been reported. In this study, we investigated the AEs of diazepam based on real data from the U.S. Food and Drug Administration (FDA) adverse event reporting system (FAERS). Methods: Disproportionality in diazepam-associated AEs was assessed through the calculation of reporting odds ratios (RORs), proportional reporting ratios (PRRs), Bayesian confidence-propagation neural networks (BCPNNs), and gamma-Poisson shrinkage (GPS). Results: Among the 19,514,140 case reports in the FAERS database, 15,546 reports with diazepam as the "principal suspect (PS)" AEs were identified. Diazepam-induced AEs occurred targeting 27 system organ categories (SOCs). Based on four algorithms, a total of 391 major disproportionate preferred terms (PTs) were filtered out. Unexpectedly significant AEs such as congenital nystagmus, developmental delays, and rhabdomyolysis were noted, which were not mentioned in the drug insert. Conclusion: Our study identified potential signals of new AEs that could provide strong support for clinical monitoring and risk identification of diazepam.
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Affiliation(s)
- Weizhen He
- Department of Neurosurgery, Xiang’an Hospital of Xiamen University, Xia Men, Fujian, China
| | - Yang Wang
- Department of Ear Nose and Throat, Xiang’an Hospital of Xiamen University, Xia Men, Fujian, China
| | - Kaiqin Chen
- Department of Neurosurgery, Xiang’an Hospital of Xiamen University, Xia Men, Fujian, China
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Tan Z, Wen Y, Yang K, Zhao X, Yang X, He J. Development and validation of the UPLC-MS method for simultaneous determination of six new psychoactive substances. RSC Adv 2022; 12:26704-26711. [PMID: 36320845 PMCID: PMC9490772 DOI: 10.1039/d2ra04869h] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 12/05/2023] Open
Abstract
The combined abuse of benzodiazepines and antipsychotics has become a global problem, and to develop a highly sensitive and selective method for monitoring of benzodiazepine hypnotics and antipsychotics is urgently necessary. In this work, we established a rapid method for the simultaneous determination of benzodiazepines (diazepam, alprazolam, triazolam, and estazolam) and antipsychotic drugs (clozapine, and chlorpromazine) based on ultra performance liquid chromatography-mass spectrometry (UPLC-MS). The accuracy, precision, limit of detection (LOD), limit of quantification (LOQ), specificity, matrix effect and carry-over effect were verified in detail. The results of the recovery and repeat experiments proved that the proposed UPLC-MS method possessed very satisfactory accuracy and precision. The LOD and LOQ of the six psychoactive substances were as low as 0.001-0.005 and 0.005-0.01 μg L-1, respectively. The proposed method was employed to analyze urine samples which were pretreated with a protein precipitation process. The potential influences of precipitants on the analysis results were evaluated statistically, and 0.1% formic acid/acetonitrile/water was selected as the optimum precipitation agent. The detection of the targets was free from matrix and carryover effects.
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Affiliation(s)
- Zhouhong Tan
- College of Pharmacy, Dali University Dali 671000 Yunnan P. R. China
- Yunnan Provincial Key Laboratory of Forensic Science Kunming 650223 Yunnan P. R. China
| | - Yunbo Wen
- Yunnan Provincial Key Laboratory of Forensic Science Kunming 650223 Yunnan P. R. China
| | - Kai Yang
- Public Security Bureau Dali Bai Autonomous Prefecture Dali 671000 Yunnan P. R. China
| | - Xia Zhao
- College of Pharmacy, Dali University Dali 671000 Yunnan P. R. China
| | - Xiaoli Yang
- College of Pharmacy, Dali University Dali 671000 Yunnan P. R. China
| | - Jieli He
- College of Pharmacy, Dali University Dali 671000 Yunnan P. R. China
- Yunnan Provincial Key Laboratory of Forensic Science Kunming 650223 Yunnan P. R. China
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Yang Y, Kong D, Li Q, Chen W, Zhao G, Tan X, Huang X, Zhang Z, Feng C, Xu M, Wan Y, Yang M. Non-antipsychotic medicines and modified electroconvulsive therapy are risk factors for hospital-acquired pneumonia in schizophrenia patients. Front Psychiatry 2022; 13:1071079. [PMID: 36713903 PMCID: PMC9880231 DOI: 10.3389/fpsyt.2022.1071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) has a significant and detrimental impact on schizophrenia patients. Non-antipsychotic medicines and modified electroconvulsive therapy (MECT) are frequently used in conjunction with antipsychotics to treat schizophrenia. Whether non-antipsychotic medicines or MECT are risk factors for HAP in schizophrenia treated with antipsychotics is still unknown. METHODS Patients with schizophrenia who were admitted to the Fourth People's Hospital of Chengdu between January 2015 and April 2022 were included in this retrospective cohort study. Individuals with HAP were 1:1 matched to individuals without HAP (non-HAP) using propensity score matching (PSM). The risk factors for HAP were analyzed by comparing the two groups. RESULTS A total of 7,085 schizophrenia patients were included in this study, with a mean age of 39.77 ± 14.45 years. 193 patients developed HAP on an average of 22.26 ± 21.68 days after admission with an incidence of 2.73%. After 1:1 PSM, 192 patients from each group (HAP and non-HAP) were included. The HAP group had significantly more patients with MECT and taking benzodiazepines, antidepressants, mood stabilizers, and anti-parkinsonians both before and after PSM by Bonferroni correction (P < 0.001). Multivariate logistic regression analysis showed that, combined with antipsychotics, non-antipsychotic medicines including benzodiazepines (OR = 3.13, 95%CI = 1.95-5.03, P < 0.001), mood stabilizers (OR =3.33, 95%CI =1.79-6.20, P < 0.001) and MECT (OR =2.58, 95%CI =1.49-4.46, P = 0.001) were associated with a significantly increased incidence of HAP. CONCLUSION The incidence of HAP in schizophrenia patients in our cohort was 2.73%. MECT and non-antipsychotic medicines, including benzodiazepines and mood stabilizers were risk factors for HAP in schizophrenia patients treated with antipsychotics.
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Affiliation(s)
- Yan Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Di Kong
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qiwen Li
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Wei Chen
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Guocheng Zhao
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xi Tan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xincheng Huang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zipeng Zhang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Can Feng
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Min Xu
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Ying Wan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Mi Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China.,MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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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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Supportive and palliative care for people with respiratory problems and preexisting serious mental illness. Curr Opin Support Palliat Care 2020; 14:190-196. [PMID: 32701857 DOI: 10.1097/spc.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW People living with serious mental illness are at a higher risk of developing respiratory problems that can lead to increased morbidity and early mortality. This review aimed to identify recent advances in care provision for people with respiratory problems and preexisting serious mental illness to ease symptom burden and reduce the risk of premature mortality. RECENT FINDINGS Intervention-based studies in this area are scarce. The evidence reviewed originated from observational studies. Concluding comments from the synthesis suggest there are specific needs for proactive screening of respiratory function as part of routine physical health checks across care settings for people living with serious mental illness, more stringent monitoring of comorbid chronic lung conditions and increased attention in reducing the frequency respiratory infections. Integrated services across care settings are needed to support people with serious mental illness to limit the impact of modifiable lifestyle factors known to be detrimental to respiratory health, such as smoking. SUMMARY Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.
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Sun GQ, Zhang L, Zhang LN, Wu Z, Hu DF. Benzodiazepines or related drugs and risk of pneumonia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2019; 34:513-521. [PMID: 30623504 DOI: 10.1002/gps.5048] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Benzodiazepines and benzodiazepine-related drugs (BZRDs) are used to treat various psychiatric diseases. However, there are concerns that BZRDs increase the risk of pneumonia. METHODS We performed a systematic review and meta-analysis of observational studies to determine whether BZRD use affects the risk of pneumonia. Our analysis included all observational studies that compared pneumonia development among patients receiving BZRD vs those with no treatment. RESULTS In total, 12 citations of 10 studies involving more than 120,000 pneumonia cases were included in our meta-analysis. After pooling the estimates, the odds for developing pneumonia were 1.25-fold higher (odd ratio, OR = 1.25; 95% confidence interval (CI), 1.09-1.44) in BZRD users compared with individuals who had not taken BZRD. On the basis of exposure window, we found an increased risk of pneumonia among current (OR = 1.4; 95%CI, 1.22-1.6) and recent (OR = 1.38; 95%CI, 1.06-1.8) users, but not with the past users (OR = 1.11; 95%CI, 0.96-1.27). CONCLUSION Current or recent exposure to BZRD is associated with an increased pneumonia risk. Clinicians need to weight the benefit-risk balance of BZRD use, especially those with other risk factors for pneumonia.
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Affiliation(s)
- Guo-Qing Sun
- Department of Psychiatry, The Seventh Hospital of Hangzhou, Hangzhou, China
| | - Lei Zhang
- Department of Psychiatry, The Seventh Hospital of Hangzhou, Hangzhou, China
| | - Li-Na Zhang
- Department of Psychiatry, The Seventh Hospital of Hangzhou, Hangzhou, China
| | - Zhe Wu
- Department of Psychiatry, The Seventh Hospital of Hangzhou, Hangzhou, China
| | - De-Feng Hu
- Department of Psychiatry, The Seventh Hospital of Hangzhou, Hangzhou, China
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