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Stip E, Rizvi TA, Mustafa F, Javaid S, Aburuz S, Ahmed NN, Abdel Aziz K, Arnone D, Subbarayan A, Al Mugaddam F, Khan G. The Large Action of Chlorpromazine: Translational and Transdisciplinary Considerations in the Face of COVID-19. Front Pharmacol 2020; 11:577678. [PMID: 33390948 PMCID: PMC7772402 DOI: 10.3389/fphar.2020.577678] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome (SARS) in humans that is caused by SARS-associated coronavirus type 2 (SARS-CoV-2). In the context of COVID-19, several aspects of the relations between psychiatry and the pandemic due to the coronavirus have been described. Some drugs used as antiviral medication have neuropsychiatric side effects, and conversely some psychotropic drugs have antiviral properties. Chlorpromazine (CPZ, Largactil®) is a well-established antipsychotic medication that has recently been proposed to have antiviral activity against SARS-CoV-2. This review aims to 1) inform health care professionals and scientists about the history of CPZ use in psychiatry and its potential anti- SARS-CoV-2 activities 2) inform psychiatrists about its potential anti-SARS-CoV-2 activities, and 3) propose a research protocol for investigating the use of CPZ in the treatment of COVID-19 during the potential second wave. The history of CPZ's discovery and development is described in addition to the review of literature from published studies within the discipline of virology related to CPZ. The early stages of infection with coronavirus are critical events in the course of the viral cycle. In particular, viral entry is the first step in the interaction between the virus and the cell that can initiate, maintain, and spread the infection. The possible mechanism of action of CPZ is related to virus cell entry via clathrin-mediated endocytosis. Therefore, CPZ could be useful to treat COVID-19 patients provided that its efficacy is evaluated in adequate and well-conducted clinical trials. Interestingly, clinical trials of very good quality are in progress. However, more information is still needed about the appropriate dosage regimen. In short, CPZ repositioning is defined as a new use beyond the field of psychiatry.
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Affiliation(s)
- Emmanuel Stip
- Department of Psychiatry, University of Montréal, Montréal, QC, Canada
- Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tahir A. Rizvi
- Department of Medical Microbiology and Immunology, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Farah Mustafa
- Department of Biochemistry, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Syed Javaid
- Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Salahdein Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nahida Nayaz Ahmed
- Ambulatory Healthcare Services, Al Maqtaa Healthcare Center, Middle Regions Clinics Division, SEHA, Abu Dhabi, United Arab Emirates
| | - Karim Abdel Aziz
- Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Danilo Arnone
- Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
- Kings’ College London, Institute of Psychiatry, Psychology, Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, United Kingdom
| | - Aravinthan Subbarayan
- Behavioral Sciences Institute (BSI), Al Ain Hospital, SEHA, Al Ain, United Arab Emirates
| | - Fadwa Al Mugaddam
- Department of Psychiatry, University of Montréal, Montréal, QC, Canada
| | - Gulfaraz Khan
- Department of Medical Microbiology and Immunology, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
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A weight-independent association between atypical antipsychotic medications and obstructive sleep apnea. Sleep Breath 2017; 22:109-114. [PMID: 28707161 DOI: 10.1007/s11325-017-1537-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increasing use of atypical antipsychotic (AAP) agents, the concern has been raised about the association between AAP agents and medical complications. Obstructive sleep apnea (OSA) is a common breathing disorder that adversely affects health and quality of life. Because the major risk factors for OSA are weight gain and obesity by altering the upper airway anatomy, an association between AAP and development of OSA is predictable. However, we hypothesized that AAP may promote OSA not only by weight gain but also because of its potential effects on upper airway muscle function. In the present study, we evaluated the possible association between AAP use and the severity of OSA. METHODS A sample of patients using AAP for treatment of paradoxical insomnia was evaluated before and at least 8 weeks after AAP use. Patients were divided based on type of AAP use to olanzapine, risperidone, and quetiapine groups. Patients used olanzapine (5-10 mg), risperidone (2-4 mg), or quetiapine (100-200 mg) 2 h before bedtime. Before and after treatment, respiratory variables were recorded using polysomnography. BMI, neck circumference (NC), and waist circumference (WC) were measured before and after treatment period. RESULTS There was no significant difference between pre- and post-treatment apnea index (0.2 ± 0.6 vs. 2.6 ± 4.3; p = 0.094) in olanzapine group. However, significant differences in hypopnea index (5.1 ± 5 vs. 30 ± 10.8; p < 0.0001) and AHI (5.3 ± 4.9 vs. 32.6 ± 9.6; p < 0.0001) were observed. Similar results were found in quetiapine and risperidone groups, except that in quetiapine group, apnea index was significantly increased after treatment period (0.7 ± 1.2 in pre-treatment vs. 3.1 ± 2.4 in post-treatment; p = 0.007). There were no significant changes in BMI, NC, and WC during treatment period in all three groups. CONCLUSION While AAP medications are known cause of weight gain as a main risk factor of OSA, our finding demonstrated a weight-independent association between AAP medications and worsening respiration during sleep.
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Dawson GR. Experimental Medicine in Psychiatry New Approaches in Schizophrenia, Depression and Cognition. Curr Top Behav Neurosci 2016; 28:475-497. [PMID: 27418068 DOI: 10.1007/7854_2015_5016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of experimental medicine studies to bridge the gap between Phase 1 and 2 drug trials and so to enhance translation of basic neuroscience studies using experimental animals to the clinic is proposed. Illustrative examples are provided for affective disorders and schizophrenia in relation also to cognitive dysfunction.
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Affiliation(s)
- Gerard R Dawson
- P1vital LTD, Manor House, Howbery Park, Wallingford, Oxfordshire, OX10 8BA, UK.
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Mohr C, Ettinger U. An Overview of the Association between Schizotypy and Dopamine. Front Psychiatry 2014; 5:184. [PMID: 25566103 PMCID: PMC4271513 DOI: 10.3389/fpsyt.2014.00184] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/05/2014] [Indexed: 12/31/2022] Open
Abstract
Schizotypy refers to a constellation of personality traits that are believed to mirror the subclinical expression of schizophrenia in the general population. Evidence from pharmacological studies indicates that dopamine (DA) is involved in the etiology of schizophrenia. Based on the assumption of a continuum between schizophrenia and schizotypy, researchers have begun investigating the association between DA and schizotypy using a wide range of methods. In this article, we review published studies on this association from the following areas of work: (1) experimental investigations of the interactive effects of dopaminergic challenges and schizotypy on cognition, motor control, and behavior (2), dopaminergically supported cognitive functions (3), studies of associations between schizotypy and polymorphisms in genes involved in dopaminergic neurotransmission, and (4) molecular imaging studies of the association between schizotypy and markers of the DA system. Together, data from these lines of evidence suggest that DA is important to the expression and experience of schizotypy and associated behavioral biases. An important observation is that the experimental designs, methods, and manipulations used in this research are highly heterogeneous. Future studies are required to replicate individual observations, to enlighten the link between DA and different schizotypy dimensions (positive, negative, cognitive disorganization), and to guide the search for solid DA-sensitive behavioral markers. Such studies are important in order to clarify inconsistencies between studies. More work is also needed to identify differences between dopaminergic alterations in schizotypy compared to the dysfunctions observed in schizophrenia.
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Affiliation(s)
- Christine Mohr
- Institute of Psychology, University of Lausanne , Lausanne , Switzerland
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn , Bonn , Germany
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Ackenheil M, Weber K. Differing response to antipsychotic therapy in schizophrenia: pharmacogenomic aspects. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22034253 PMCID: PMC3181786 DOI: 10.31887/dcns.2004.6.1/mackenheil] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Treatment-resistance in schizophrenia remains a public health problem: about 20% to 30% of patients do not respond to antipsychotic therapy. Clozapine has been shown to be effective in about one-third of patients, but the medical risks and weekly blood tests limit its broad application. While the heterogeneity of the disease and the duration of untreated psychosis are important, pharmacogenomic aspects must also be considered. Pharmacogenomic investigations offer the opportunity to individualize antipsychotic therapy according to the growing knowledge of the function and effect of the genetic polymorphisms that affect the pharmacokinetics and pharmacodynamics of antipsychotics. On the pharmacokinetic level, polymorphic phase I and II drug-metabolizing enzymes and transport proteins affect drug concentration at the target structure. The cytochrome P450 enzymes, N-acetyltransferase, and multidrug resistance protein (MDR1) particularly influence this parameter. Genetic alterations affecting drug pharmacodynamic properties have an impact on therapeutic outcome that is generally independent of the applied dosage regimen. A combined analysis of genetic polymorphisms in the dopaminergic and serotonergic receptors, neurotransmitter transporters, and other target structures involved in psychiatric disorders is already a powerful predictor of therapeutic outcome. An understanding of other factors influencing gene expression and protein production will facilitate individualized therapy in the future.
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Roth S, Kinne A, Schweizer U. The tricyclic antidepressant desipramine inhibits T3 import into primary neurons. Neurosci Lett 2010; 478:5-8. [DOI: 10.1016/j.neulet.2010.04.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/06/2010] [Accepted: 04/22/2010] [Indexed: 11/29/2022]
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Stip E. Re: Case reports as letters should stay in the Canadian Journal of Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:878. [PMID: 16483125 DOI: 10.1177/070674370505001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mohr C, Krummenacher P, Landis T, Sandor PS, Fathi M, Brugger P. Psychometric schizotypy modulates levodopa effects on lateralized lexical decision performance. J Psychiatr Res 2005; 39:241-50. [PMID: 15725422 DOI: 10.1016/j.jpsychires.2004.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/18/2004] [Accepted: 08/20/2004] [Indexed: 11/16/2022]
Abstract
Emergence of psychotic thought has been related to a breakdown in left-hemisphere language dominance. Dopamine (DA) is implicated in both psychotic pathology and modulation of the semantic system. The present study explored whether controlled DA administration modulates basic language functions: (1) in general and/or (2) as a function of schizophrenia-associated thought. Forty healthy men performed a tachistoscopic lexical decision task. Participants' performance was also analyzed as a function of their positive (magical ideation, MI) and negative (physical anhedonia, PHYSAN) schizotypal features. Half of the subjects received 200 mg levodopa, the other half a placebo. Our findings showed that pharmacological treatment per se did not influence task performance, but influenced laterality patterns as a function of participants' schizotypal features. In the placebo, but not in the levodopa group, right hemisphere language contribution increased as a function of increasing MI scores. In the levodopa, but not in the placebo group, superior left hemisphere lexical decision performance was related to increasing PHYSAN scores. The findings from both substance groups suggest that in the healthy brain, a DA agonist restores left-hemispheric dominance for language by reducing right-hemispheric contribution with respect to a positive schizotypal trait and by increasing left-hemispheric specialization with respect to a negative schizotypal trait. We conjecture that the healthy brain compensates through intact neurochemical mechanisms an increased DA concentration, in particular for persons with elevated positive psychotic-like features.
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Affiliation(s)
- Christine Mohr
- Department of Neurology, Functional Brain Mapping Laboratory, University Hospital Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland.
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Stip E. [Psychiatry without influence: schizoanalysis at the edge of the window]. SANTE MENTALE AU QUEBEC 2005; 30:Suppl 149-64. [PMID: 16170433 DOI: 10.7202/011276ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Emmanuel Stip
- Psychiatre, Centre de recherche Fernand Seguin, Hôpital L.H. Lafontaine, Pavillon Albert Prévost, Chaire de schizophrénie, Université de Montréal
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Abstract
Although the standard of care in developed countries is to maintain schizophrenia patients on neuroleptics, this practice is not supported by the 50-year research record for the drugs. A critical review reveals that this paradigm of care worsens long-term outcomes, at least in the aggregate, and that 40% or more of all schizophrenia patients would fare better if they were not so medicated. Evidence-based care would require the selective use of antipsychotics, based on two principles: (a). no immediate neuroleptisation of first-episode patients; (b). every patient stabilized on neuroleptics should be given an opportunity to gradually withdraw from them. This model would dramatically increase recovery rates and decrease the percentage of patients who become chronically ill.
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