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Schoretsanitis G, Anıl Yağcıoğlu AE, Ruan CJ, Eap CB, Molden E, Baptista T, Clark SR, Fernandez-Egea E, Kim SH, Lane HY, Leung J, Maroñas Amigo O, Motuca M, Olmos I, Every-Palmer S, Procyshyn RM, Rohde C, Satish S, Schulte PFJ, Spina E, Takeuchi H, Verdoux H, Correll CU, de Leon J. Clozapine ultrarapid metabolism during weak induction probably exists but requires careful diagnosis. A literature review, five new cases and a proposed definition. Schizophr Res 2024; 268:302-307. [PMID: 37268453 DOI: 10.1016/j.schres.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023]
Abstract
During weak induction (from smoking and/or valproate co-prescription), clozapine ultrarapid metabolizers (UMs) need very high daily doses to reach the minimum therapeutic concentration of 350 ng/ml in plasma; clozapine UMs need clozapine doses higher than: 1) 900 mg/day in patients of European/African ancestry, or 2) 600 mg/day in those of Asian ancestry. Published clozapine UMs include 10 males of European/African ancestry, mainly assessed with single concentrations. Five new clozapine UMs (two of European and three of Asian ancestry) with repeated assessments are described. A US double-blind randomized trial included a 32-year-old male smoking two packages/day with a minimum therapeutic dose of 1,591 mg/day from a single TDM during open treatment of 900 mg/day. In a Turkish inpatient study, a 30-year-old male smoker was a possible clozapine UM needing a minimum therapeutic dose of 1,029 mg/day estimated from two trough steady-state concentrations on 600 mg/day. In a Chinese study, three possible clozapine UMs (all male smokers) were identified. The clozapine minimum therapeutic dose estimated with trough steady-state concentrations >150 ng/ml was: 1) 625 mg/day, based on a mean of 20 concentrations in Case 3; 2) 673 mg/day, based on a mean of 4 concentrations in Case 4; and 3) 648 mg/day, based on a mean of 11 concentrations in Case 5. Based on these limited studies, clozapine UMs during weak induction may account for 1-2% of clozapine-treated patients of European ancestry and <1% of those of Asian ancestry. A clozapine-to-norclozapine ratio <0.5 should not be used to identify clozapine UMs.
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Affiliation(s)
- Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland; Division of Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, New York, NY, USA; Department of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | | | - Can-Jun Ruan
- The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 23 Vinderen, 0319 Oslo, Norway; Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Trino Baptista
- Department of Physiology, Los Andes University Medical School, Mérida, Venezuela; Medical School, Anáhuac University, Querétaro, Mexico; Neuroorigen, Querétaro, Mexico
| | - Scott R Clark
- University of Adelaide, Discipline of Psychiatry, Adelaide, Australia.
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, Cambridge, UK.
| | - Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hsien-Yuan Lane
- Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Jonathan Leung
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
| | - Olalla Maroñas Amigo
- Genomic Medicine Group, Galician Public Foundation of Genomic Medicine (FPGMX), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain; Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Center for Biomedical Research in Rare Diseases Network, Carlos III Health Institute, Madrid, Spain.
| | - Mariano Motuca
- Department of Psychiatry, School of Medicine at Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Ismael Olmos
- Clinical Pharmacology Unit, Pharmacy Department, Vilardebó Hospital, Administración de Servicios de Salud (ASSE), Montevideo, Uruguay.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand.
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada.
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Suhas Satish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Peter F J Schulte
- Mental Health Services Noord-Holland-Noord, Alkmaar, Netherlands; Dutch Clozapine Collaboration Group, Castricum, Netherlands.
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Hélène Verdoux
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.
| | - Christoph U Correll
- Division of Psychiatry Research, Northwell Health, The Zucker Hillside Hospital, New York, NY, USA; Department of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
| | - 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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Leavens ELS, Lambart L, Diaz FJ, Wagener TL, Ahluwalia JS, Benowitz N, Nollen NL. Nicotine Delivery and Changes in Withdrawal and Craving During Acute Electronic Cigarette, Heated Tobacco Product, and Cigarette Use Among a Sample of Black and White People Who Smoke. Nicotine Tob Res 2024; 26:780-784. [PMID: 38097340 PMCID: PMC11109490 DOI: 10.1093/ntr/ntad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers. AIMS AND METHODS Twenty-two nicotine-deprived people who smoke (black [n = 12] and white [n = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal. RESULTS UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p < .001) and HTP (p < .01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p = .047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p < .001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette. CONCLUSIONS Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. IMPLICATIONS Use of participant's UBCs (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and HTP. Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of black and white people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking.
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Affiliation(s)
- Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Leah Lambart
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Francisco J Diaz
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Neal Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
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Jiménez-Fernández S, Gurpegui M, Correll CU, de Leon J, Schoretsanitis G. A Systematic Review of Clozapine Concentration-Dose Ratio from Therapeutic Drug Monitoring Studies in Children and Adolescents Treated with Clozapine for Mental Disorders. Ther Drug Monit 2024; 46:170-180. [PMID: 38018845 PMCID: PMC10930379 DOI: 10.1097/ftd.0000000000001154] [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: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Therapeutic drug monitoring of clozapine in children and adolescents has received insufficient attention. Calculation of concentration-to-dose (C/D) ratios from trough steady-state concentrations estimate drug clearance. METHODS A systematic electronic literature search was conducted in 3 article databases from inception until January 10, 2023, and articles reporting clozapine concentrations in children and adolescents were retrieved. The pharmacokinetic quality of the studies was assessed, and clozapine C/D ratios were calculated using the sample mean clozapine dose and concentration. RESULTS Of the 37 articles of potential interest, only 7 reported clozapine trough and steady-state concentrations. After excluding case reports and a study confounded by fluvoxamine, 4 studies on psychosis from Europe and the United States were included. The clozapine C/D ratios were similar to published adult values and ranged from 0.82 to 1.24 with a weighted mean of 1.08 ng/mL per mg/d. The weighted means were 334 mg/d for the dose and 380 ng/mL for the concentration. The stratified analysis of the weighted mean clozapine C/D ratios from 2 studies showed lower values in 52 male (1.05 ng/mL per mg/d) than in 46 female (1.46 ng/mL per mg/d) children and adolescents, with values similar to those reported for European adult nonsmokers. Two female adolescents had high clozapine C/D ratios (2.54 ng/mL per mg/d), an Asian American patient with borderline obesity and a patient with intellectual disability with low dosage (mean = 102 mg/d) and concentration (mean = 55 ng/mL). CONCLUSIONS Reports on clozapine therapeutic drug monitoring in children and adolescents are limited in number and quality. Future studies should focus on basic pharmacokinetic issues, such as stratification by sex, smoking, and relevant comedications with inductive or inhibitory properties.
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Affiliation(s)
- Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Virgen de Las Nieves University Hospital, Granada, Spain
- CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Spain
| | - Manuel Gurpegui
- CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Spain
- Granada Center for Psychiatric Studies, Granada, Spain
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
| | - Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain; and
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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Flanagan RJ, Obee SJ, Kim AHM, Every-Palmer S. Effect of Coffee and Chocolate Ingestion on Clozapine Dose and on Plasma Clozapine and Norclozapine Concentrations in Clinical Practice. J Clin Psychopharmacol 2024; 44:161-167. [PMID: 38421925 DOI: 10.1097/jcp.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Some reports point to dietary caffeine intake as a cause of increased plasma clozapine concentrations in certain patients. METHODS We compared clozapine dose and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in male and female smokers and nonsmokers in relation to reported (i) coffee (caffeine) and (ii) chocolate (caffeine and theobromine) intake in samples submitted for clozapine therapeutic drug monitoring, 1993-2017. RESULTS There was information on coffee ingestion for 16,558 samples (8833 patients) from males and 5886 samples (3433 patients) from females and on chocolate ingestion for 12,616 samples (7568 patients) from males and 4677 samples (2939 patients) from females. When smoking was considered, there was no discernible effect of either coffee or chocolate ingestion either on the median dose of clozapine or on the median plasma clozapine and norclozapine concentrations in men and in women. However, cigarette smoking was associated with higher coffee and chocolate consumption. Although male nonsmokers who reported drinking 3 or more cups of coffee daily had significantly higher median plasma clozapine and norclozapine concentrations than those who drank less coffee, they were also prescribed a significantly higher clozapine dose. There was no clear effect of coffee ingestion on plasma clozapine and norclozapine in female nonsmokers. IMPLICATIONS Inhibition of clozapine metabolism by caffeine at the doses of caffeine normally encountered in those treated with clozapine is unlikely even in male nonsmokers. Measurement of plasma caffeine in an appropriate sample should be considered in any future investigation into a presumed clozapine-caffeine interaction.
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Affiliation(s)
- Robert James Flanagan
- From Precision Medicine, Networked Services, Bessemer Wing, King's College Hospital NHS Foundation Trust, London, England
| | - Stephen John Obee
- From Precision Medicine, Networked Services, Bessemer Wing, King's College Hospital NHS Foundation Trust, London, England
| | | | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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5
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Dinç E, Üçer A, Ünal N. A multiway spectral analysis model to monitor the kinetic chlorination reaction of caffeine and determine its content in commercial liquid and solid drinks. Food Chem 2023; 421:136139. [PMID: 37094398 DOI: 10.1016/j.foodchem.2023.136139] [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: 12/20/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023]
Abstract
A multiway data analysis model, namely parallel factor analysis (PARAFAC) was proposed to decompose a three-way array of second-order kinetic UV measurements, for the chlorination reaction of caffeine with NaOCl, into a set of the spectra, time, and concentration matrices. The multiway resolution provided the simultaneous estimation of spectral, kinetic, and quantitative analysis of caffeine. The ability of the PARAFAC tool was checked by analyzing the validation samples in the presence of interferences. The added recovery and relative standard deviations for caffeine in the spiked samples were calculated as 99.1%-99.5% and 0.52%-1.34% for Iced Coffee Black liquid coffee (ICB), 99.5%-103.0% and 0.42%-1.03% for Jacobs Monarch Gold 100% Instant Coffee (JMG) and 99.5%-101.4% and 0.11%-0.13% for Çaykur Black Filter (Süzen) Bag Tea (BTB). Caffeine in commercial drinks was analyzed using the concentration matrices of the PARAFAC application. The PARAFAC results were statistically compared to those obtained by the developed UPLC method.
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Affiliation(s)
- Erdal Dinç
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, 06560 Yenimahalle, Ankara, Turkey.
| | - Asiye Üçer
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, 06560 Yenimahalle, Ankara, Turkey; Department of Analytical Chemistry, Faculty of Pharmacy, Ankara Yıldırım Beyazıt University, 06010 Etlik, Keçiören, Ankara, Turkey
| | - Nazangül Ünal
- Department of Analytical Chemistry, Faculty of Pharmacy, Ankara University, 06560 Yenimahalle, Ankara, Turkey; Department of Pharmacy Services, Eşme Vocational School, Uşak University, 64600 Uşak, Turkey
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Rosen RL, Ramasubramani RS, Benowitz NL, Gandhi KK, Williams JM. Caffeine levels and dietary intake in smokers with schizophrenia and bipolar disorder. Psychiatry Res 2023; 319:114989. [PMID: 36470161 DOI: 10.1016/j.psychres.2022.114989] [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: 02/16/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
Caffeine is one of the most widely used psychoactive drugs in the United States. High rates of caffeine use have been observed in adult smokers as well as those with serious mental illness. The current secondary analysis aimed to extend previous findings demonstrating high caffeine intake in schizophrenia by examining dietary intake of caffeine and serum caffeine levels in outpatient smokers with schizophrenia (SCZ), bipolar disorder (BP) and control smokers with no psychiatric diagnoses (CON). Two hundred forty-eight adult smokers (SCZ=80; BP=80; CON=88) were included in the current study. Adult smokers with schizophrenia, bipolar disorder, and no psychiatric diagnoses were 40.85 (SD = 11.90) years old on average and all participants were current smokers (∼20 cigarettes per day). Twenty-four hour self-reported caffeine intake (in mg) was highest among individuals with bipolar disorder (median=195.3), followed by adults with schizophrenia (median=155.0) and controls (median=131.7). Participants with bipolar disorder also had the highest serum caffeine levels (in ng/ml; median=1725), followed by those with schizophrenia (median=1194) and controls (median=613.2). These results provide additional evidence of high caffeine intake among adults with schizophrenia and extend findings by identifying even higher rates of caffeine use in those with bipolar disorder. The current study suggests that caffeine intake is higher among subgroups of patients with serious mental illness.
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Affiliation(s)
- Rachel L Rosen
- Rutgers, The State University of New Jersey, Department of Psychology, 152 Frelinghuysen Road, Piscataway, NJ 08854, United States
| | - Rahul S Ramasubramani
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, 317 George Street, Suite 105, New Brunswick, NJ 08901, United States
| | - Neal L Benowitz
- University of California San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - Kunal K Gandhi
- Novartis, Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ 07936, United States
| | - Jill M Williams
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, 317 George Street, Suite 105, New Brunswick, NJ 08901, United States.
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de Leon J, Schoretsanitis G, Kane JM, Ruan CJ. Using therapeutic drug monitoring to personalize clozapine dosing in Asians. Asia Pac Psychiatry 2020; 12:e12384. [PMID: 32119764 DOI: 10.1111/appy.12384] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/19/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
This narrative review on clozapine blood levels or therapeutic drug monitoring (TDM) includes sections focused on drug clearance and TDM, personalized dosing with TDM, clinical applications of TDM in Asians, and areas needing further study. Asian patients need half the clozapine dose (D) used in the United States to get the same blood concentrations (C). The concentration-to-dose (C/D) ratio measures drug clearance. In the United States, the average clozapine patient usually needs from 300 to 600 mg/day to reach 350 ng/mL. US male smokers reach this therapeutic C with a D of 600 mg/day (C/D ratio of 0.60 = 600/350), whereas US female nonsmokers usually need a D of 300 mg/day (C/D ratio of 1.17 = 300/350). While in the United States, average CLO C/D ratios typically are 0.6-1.2 ng/mL per mg/day, in Asian populations they range from 1.20 in male smokers to 2.40 in female smokers, requiring Ds of 300 to 150 mg/day to obtain 350 ng/mL. Asian patients can become clozapine poor metabolizers (PMs), needing very low Ds (50-150 mg/day) to get therapeutic Cs, by taking inhibitors (fluvoxamine, oral contraceptives and valproic acid), due to obesity, or during inflammations with systemic effects. In 573 Asian patients from five samples, around 1% were PMs due to taking inhibitors, 1% due to inflammation, 1% due to obesity, and 7% were potential genetic PMs. The potential genetic PMs ranged between 3% and 13%, but this prevalence will have to be better established in future studies including genetic testing for possible CYP1A2 mutations, which may explain PM status.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky.,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
| | - Georgios Schoretsanitis
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - John M Kane
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology & The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
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8
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Ruan CJ, de Leon J. Is there a future for CYP1A2 pharmacogenetics in the optimal dosing of clozapine? Pharmacogenomics 2020; 21:369-373. [PMID: 32308139 DOI: 10.2217/pgs-2020-0015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology & The National Clinical Research Center for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY 40511, USA.,Psychiatry & 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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9
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Djordjevic N, Radmanovic B, Cukic J, Baskic D, Djukic-Dejanovic S, Milovanovic D, Aklillu E. Cigarette smoking and heavy coffee consumption affecting response to olanzapine: The role of genetic polymorphism. World J Biol Psychiatry 2020; 21:29-52. [PMID: 30513034 DOI: 10.1080/15622975.2018.1548779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: To evaluate the effect of cigarette smoking and heavy coffee consumption on efficacy and safety of olanzapine treatment in schizophrenia patients, in relation to genetic polymorphism.Methods: The study involved 120 patients with schizophrenia, treated with olanzapine for 30 days. Therapy efficacy was determined using three different psychiatric scales, and safety by assessing metabolic adverse effects and extrapyramidal symptoms. Genotyping included CYP1A2*1C, CYP1A2*1F and CYP1A1/1A2 intergenic polymorphism, as well as CYP2D6*3, CYP2D6*4 and CYP2D6*6.Results: Cigarette smoking and heavy coffee consumption decreased the efficacy and increased the safety of olanzapine treatment (P < 0.001). Although the effect was detected only in carriers of CYP1A2*1F allele, covariate analysis revealed that it is independent of CYP1A2 genotype. Olanzapine dose was inversely correlated with the drug efficacy (P ≤ 0.002) and LDL level (P = 0.004). Women and older subjects responded better to therapy (P < 0.026), but had more certain adverse effects (P ≤ 0.049). When controlling for other relevant factors, CYP2D6 metabolizer status affects olanzapine efficacy (P = 0.032).Conclusions: We confirm the effect of cigarette smoking and heavy coffee consumption on olanzapine efficacy and safety. The relevance of CYP1A2 genotype for the described effect needs further investigation. Olanzapine treatment outcome is also affected by dose, sex, age and CYP2D6 metabolizer status.
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Affiliation(s)
- Natasa Djordjevic
- Department of Pharmacology and toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Branimir Radmanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Psychiatry Clinic, Clinical Centre "Kragujevac", Kragujevac, Serbia
| | | | - Dejan Baskic
- Department of Microbiology and immunology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Dragan Milovanovic
- Department of Pharmacology and toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Costa R, Teasdale S, Abreu S, Bastos T, Probst M, Rosenbaum S, Ward PB, Corredeira R. Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia. Issues Ment Health Nurs 2019; 40:851-860. [PMID: 31339786 DOI: 10.1080/01612840.2019.1642426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.
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Affiliation(s)
- Raquel Costa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District , Bondi Junction , Australia.,School of Psychiatry, UNSW Sydney , Australia
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Tânia Bastos
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto , Porto , Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI , Maia , Portugal
| | - Michel Probst
- Faculty of Kinesiology and Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation , KU Leuven , Leuven , Belgium
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney , Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney , Randwick , Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney , Australia.,Schizophrenia Research Unit, South Western Sydney Local Health District & Ingham Institute for Applied Medical Research , Liverpool , Australia
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
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11
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Teasdale SB, Ward PB, Samaras K, Firth J, Stubbs B, Tripodi E, Burrows TL. Dietary intake of people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2019; 214:251-259. [PMID: 30784395 DOI: 10.1192/bjp.2019.20] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is thought to be associated with lower diet quality and adverse eating behaviours contributing towards physical health disparities. A rigorous review of the studies looking at dietary intake in psychotic disorders and bipolar disorder is lacking.AimsTo conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder. METHOD Six electronic databases were searched for studies reporting on dietary intakes in psychotic disorders and bipolar disorder. Dietary-assessment methods, and dietary intakes, were systematically reviewed. Where possible, data was pooled for meta-analysis and compared with healthy controls. RESULTS In total, 58 eligible studies were identified. People with SMI were found to have significantly higher dietary energy (mean difference 1332 kJ, 95% CI 487-2178 kJ/day, P = 0.002, g = 0.463) and sodium (mean difference 322 mg, 95% CI 174-490 mg, P < 0.001, g = 0.414) intake compared with controls. Qualitative synthesis suggested that higher energy and sodium intakes were associated with poorer diet quality and eating patterns. CONCLUSIONS These dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI.Declaration of interestS.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.
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Affiliation(s)
- Scott B Teasdale
- Senior Mental Health Dietitian,Keeping the Body in Mind Program,South Eastern Sydney Local Health District; andSchool of Psychiatry,University of New South Wales,Australia
| | - Philip B Ward
- Professor of Psychiatry,School of Psychiatry,University of New South Wales;Schizophrenia Research Unit,South Western Sydney Local Health District; and Ingham Institute for Applied Medical Research,Australia
| | - Katherine Samaras
- Senior Staff Specialist (Endocrinology),Department of Endocrinology,St Vincent's Hospital; Diabetes and Metabolism Division,Garvan Institute of Medical Research; andSt Vincent's Clinical School,University of New South Wales,Australia
| | - Joseph Firth
- Senior Research Fellow, NICM Health Research Institute, Western Sydney University, Australia; andDivision of Psychology and Mental Health, Faculty of Biology, Medicine and Health,University of Manchester,UK
| | - Brendon Stubbs
- Head of Physiotherapy,Physiotherapy Department,South London and Maudsley NHS Foundation Trust; andHealth Service and Population Research Department and Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience,King's College London,UK
| | - Elise Tripodi
- Mental Health Dietitian,Keeping the Body in Mind Program,South Eastern Sydney Local Health District,Australia
| | - Tracy L Burrows
- Associate Professor in Nutrition and Dietetics,School of Health Sciences and Priority Research Centre for Physical Activity and Nutrition,University of Newcastle,Australia
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12
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Chopra N, Ruan CJ, McCollum B, Ognibene J, Shelton C, de Leon J. High Doses of Drugs Extensively Metabolized by CYP3A4 Were Needed to Reach Therapeutic Concentrations in Two Patients Taking Inducers. ACTA ACUST UNITED AC 2018; 49:84-95. [PMID: 32446424 DOI: 10.1016/j.rcp.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION In the last 20 years of clinical practice, the senior author has identified these 2 rare cases in which the patients needed extremely high doses of drugs metabolized by CYP3A4 to reach and maintain serum therapeutic concentrations. METHODS The high metabolic ability of these 2 patients was demonstrated by the low concentration-to-dose ratios (C/D ratios) of several drugs metabolized by CYP3A4. RESULTS Case 1 was characterized by a history of high carbamazepine doses (up to 2,000mg/day) and needed 170 mg/day of diazepam in 2 days to cooperate with dental cleaning. The high activity of the CYP3A4 isoenzyme was manifested by fast metabolism for quetiapine and diazepam, which took more than 1 year to normalize after the inducer, phenytoin, was stopped. Case 2 was also very sensitive to CYP3A4 inducers as indicated by very low C/D ratios for carbamazepine, risperidone and paliperidone. The carbamazepine (2,800 mg/day) and risperidone (20 mg/day) dosages for this second patient are the highest doses ever seen for these drugs by the senior author. Risperidone induction appeared to last for many months and metabolism was definitively normal 3 years after stopping carbamazepine. On the other hand, olanzapine C/D ratios were normal for induction. CONCLUSIONS The literature has never described similar cases of very high doses of drugs metabolized by CYP3A4. We speculate that these 2 patients may have unusual genetic profiles at the nuclear receptor levels; these receptors regulate induction of drugs.
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Affiliation(s)
- Nitin Chopra
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Judy Ognibene
- Apalachee, Inc., Eastside Psychiatric Hospital, Tallahassee, Florida, USA
| | | | - Jose de Leon
- University of Kentucky Mental Health Research Center, Eastern State Hospital, Lexington, Kentucky, 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, Álava, Spain.
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13
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Mallet J, Le Strat Y, Schürhoff F, Mazer N, Portalier C, Andrianarisoa M, Aouizerate B, Berna F, Brunel L, Capdevielle D, Chereau I, D'Amato T, Denizot H, Dubreucq J, Faget C, Gabayet F, Lançon C, Llorca PM, Misdrahi D, Rey R, Roux P, Schandrin A, Urbach M, Vidailhet P, Fond G, Dubertret C. Cigarette smoking and schizophrenia: a specific clinical and therapeutic profile? Results from the FACE-Schizophrenia cohort. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:332-339. [PMID: 28663115 DOI: 10.1016/j.pnpbp.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/17/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tobacco use is common in patients with schizophrenia (SZ) but little is known on the role of tobacco in the physiopathology or on the course of the disease. Only few studies embrace an extensive examination of clinical and therapeutic characteristics in stabilized patients. The objective of the present study was to determine the prevalence of tobacco smoking in stabilized SZ outpatients and the clinical and treatment characteristics associated with daily tobacco use in a large community-dwelling sample of patients. METHODS Three-hundred-and-sixty-one patients were included in the network of the FondaMental Expert Centers for Schizophrenia. Current tobacco status was self-declared. RESULTS 53.7% were smokers. Mean age at tobacco onset was 17.2years old. In multivariate analyses, after adjustment for confounding factors, positive symptoms and mean daily antipsychotic dose were associated with a higher frequency of tobacco use (OR=1.06 95%IC[1.02-1.12], for positive symptoms, OR=1.1, 95%IC[1.02-1.18] for daily antipsychotic dose). Education level, negative symptoms, anticholinergic agents, clozapine or aripiprazole administration were independently associated with a lower frequency of tobacco use (respectively OR=0.87, 95%IC [0.79, 0.95], OR=0.95, 95%IC[0.91-0.98], OR=0.41, 95%IC[0.22-0.76], OR=0.56, 95%IC=[0.32, 0.99] and OR=0.49, 95%IC [0.26-0.91]). CONCLUSION The prevalence of current tobacco smoking in a French community-dwelling SZ patients is higher that observed in the general population. Patients with tobacco use present clinical and therapeutic specificities that may involve interaction between cholinergic-nicotinic and dopaminergic systems. The present study suggests that some therapeutics may improve daily smoking behavior in smokers. These results should be confirmed in longitudinal studies.
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Affiliation(s)
- J Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France.
| | - Y Le Strat
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - N Mazer
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - C Portalier
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - M Andrianarisoa
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Bordeaux Sleep Clinique, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Research Unit, 33000 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Équipe de psychiatrie translationnelle, Créteil, France; Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - H Denizot
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Faget
- Fondation FondaMental, Créteil, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, F-13274 Marseille Cedex 09, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C Lançon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon,Université Claude Bernard Lyon 1, Equipe PSlYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - P Roux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - G Fond
- Fondation FondaMental, Créteil, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm U894, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
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