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Javelot H, Dizet S, Straczek C, Langrée B, Michel B, Haffen E, Bertschy G. Enhancing the role played by clinical pharmacists in psychiatric settings to better integrate clinical psychopharmacology into the decision-making process. Therapie 2020; 76:149-156. [PMID: 33358640 DOI: 10.1016/j.therap.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023]
Abstract
The importance of clinical psychopharmacological knowledge for modern psychiatric care is both well-established and underdeveloped. Although psychiatric pharmacists are identified as experts in psychopharmacotherapy based on pharmacists' overall expertise in pharmacotherapy, in real-life health settings, such is not necessarily the case. As a matter of fact, (1) pharmacists' real expertise in pharmacotherapy is mainly seen as useful to patients (as part of therapeutic education), (2) pharmacists' practice methods are usually circumscribed to the framework of quality processes (e.g. comprehensive medication management) which are not particularly useful to clinicians who have a greater need for pharmacotherapeutic skills, (3) the difficulties in terms of collaboration between pharmacists and physicians are well-known. We describe here the implementation of an alternative system of pharmacotherapy counselling inspired by case by cases in which the remote expertise of pharmacists in psychopharmacology guided prescribers towards the implementation of recommendations from the literature. This shared decision-making process integrates both the clinical elements provided by the psychiatrist and the pharmacotherapeutic information provided by the clinical psychopharmacist, to promote evidence-based medicine (algorithmic data in recommendations) and tailor-made solutions (drug-drug and drug-disease interactions) for patients. In our experience, the success of such an initiative is likely to promote the development of clinical psychopharmacology in psychiatric settings. Importantly, within this framework, the pharmacovigilance unit and psychopharmacologist are useful resources to guide the decision-making process of the pharmacist-psychiatrist duo.
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Affiliation(s)
- Hervé Javelot
- Établissement public de santé Alsace Nord, Établissement public de Santé mentale Alsace Nord (EPSAN), 67170 Brumath, France; UR 7296 laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, 67000 Strasbourg, France.
| | - Sophie Dizet
- Centre de ressources et d'expertise en psychopharmacologie (CREPP) Bourgogne Franche-Comté et service pharmacie, CHS de Sevrey, 71100 Chalon sur Saône, France
| | - Céline Straczek
- Département de pharmacie, CHU Henri Mondor, 94000 Créteil, France; Institut Mondor de recherche biomédicale, Inserm U955, équipe 15 neuropsychiatrie translationnelle, 94000 Créteil, France
| | - Bastien Langrée
- Service pharmacie, centre hospitalier Guillaume Régnier, 35000 Rennes, France
| | - Bruno Michel
- Department of pharmacy, university hospital of Strasbourg, NHC, 67000 Strasbourg, France; Faculty of pharmacy, university of Strasbourg, 67000 Strasbourg, France; UR 7296 laboratory of neuro-cardiovascular pharmacology and toxicology, university of Strasbourg, 67000 Strasbourg, France
| | - Emmanuel Haffen
- Service de psychiatrie, CIC-1431 INSERM, CHU de Besançon, 25000 Besançon, France; Laboratoire de neurosciences, université de Franche-Comté, 25000 Besançon, France
| | - Gilles Bertschy
- Pôle de psychiatrie, santé mentale & addictologie des hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Inserm U1114, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
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Delorme C, Adanyeguh I, Bendetowicz D, Le Ber I, Ponchel A, Kas A, Habert MO, Mochel F. Multimodal neurometabolic investigation of the effects of zolpidem on leukoencephalopathy-related apathy. Eur J Neurol 2020; 27:2297-2302. [PMID: 32757342 DOI: 10.1111/ene.14465] [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: 05/25/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The symptomatic effect of zolpidem on apathy has been reported in neurological disorders such as strokes and post-anoxic brain injuries, but not in white-matter disease of the brain. METHODS A 38-year-old patient presenting with severe apathy related to a genetic leukoencephalopathy but showing marked improvement of apathy after taking 10 mg of zolpidem was studied. To understand what may mediate such a clinical effect, a multimodal neurometabolic approach using 18 F fluorodeoxyglucose positron emission tomography (FDG-PET) and a dedicated magnetic resonance spectroscopy (MRS) sequence for gamma aminobutyric acid (GABA) and glutamine + glutamate metabolism was undertaken. RESULTS Pre-zolpidem FDG-PET showed hypometabolism in the orbitofrontal cortex, dorsolateral cortex and basal ganglia compared to healthy controls. Post-zolpidem, FDG-PET displayed increased metabolism in the orbitofrontal cortex together with improvement in the emotional and auto-activation domains of apathy. There was no improvement in the cognitive domain of apathy, and no change in metabolism in the dorsolateral frontal cortex. Post-zolpidem, MRS showed increased GABA and glutamine + glutamate levels in the frontal cortex and pallidum. CONCLUSION Our multimodal neurometabolic study suggests that the effects of zolpidem on apathy are related to increased metabolism in the orbitofrontal cortex and basal ganglia secondary to GABA modulation. Zolpidem may improve apathy in other white-matter disorders.
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Affiliation(s)
- C Delorme
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - I Adanyeguh
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - D Bendetowicz
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France
| | - I Le Ber
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Reference Centre for Rare or Early Dementias, IM2A, Paris, France.,Institut du Cerveau et de la Moelle Epiniere (ICM), Frontlab, Paris, France
| | - A Ponchel
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France
| | - A Kas
- Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Sorbonne Université, Paris, France.,Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - M-O Habert
- Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Sorbonne Université, Paris, France.,Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - F Mochel
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Department of Genetics, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
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Lucchelli JP, Kourakou S, de Lucia Bové LP, Rodriguez DD. Lorazepam-Resistant Catatonia in an Antipsychotic-Naïve 24-Year-Old with Psychotic Symptoms. Case Rep Psychiatry 2020; 2020:2469707. [PMID: 32318305 PMCID: PMC7165349 DOI: 10.1155/2020/2469707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 11/17/2022] Open
Abstract
Catatonia is a complex identifiable clinical syndrome characterized primarily by psychomotor symptoms. In recent decades, some authors have considered that catatonia can be presented as a catatonic syndrome in several pathologies such as bipolar disorder, schizophrenia and other psychotic disorders and not only in schizophrenia. Prior to DSM 5, there were two conceptions of catatonia: one in which clinical characterization seemed to play a determining role (a categorical view) and another in which a dimensional perspective advocated the existence of catatonia as a clinical entity in its own right, detached from the underlying pathology. Although there are no definitive consensus guidelines for the treatment of catatonia, some studies show that in the schizophrenic form of catatonia, benzodiazepines are partially effective, as well as treatment with ECT. We present the case of a 24-year-old man with severe catatonia and psychotic symptoms, resistant to lorazepam treatment, who achieved complete remission with clozapine treatment according to our diagnostic hypothesis of schizophrenia.
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Affiliation(s)
- Juan Pablo Lucchelli
- Hôpital du Jura Bernois, Pôle de Santé Mentale, L'Abbaye 22713 Bellelay, Switzerland
- Laboratoire de Psychopathologie, E.A. 4050, Université de Rennes 2, France
| | - Stamatia Kourakou
- Hôpital du Jura Bernois, Pôle de Santé Mentale, L'Abbaye 22713 Bellelay, Switzerland
| | | | - Daniel Diaz Rodriguez
- Hôpital du Jura Bernois, Pôle de Santé Mentale, L'Abbaye 22713 Bellelay, Switzerland
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Huang TL, Lin CC, Chen HL, Lu CH. Catatonia Rating Scales in Patients with Persistent Vegetative State. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Treatment of Catatonia in Frontotemporal Dementia: A Lesson From Zolpidem Test. Clin Neuropharmacol 2019; 42:186-187. [DOI: 10.1097/wnf.0000000000000362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sienaert P, van Harten P, Rhebergen D. The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:415-428. [PMID: 31727227 DOI: 10.1016/b978-0-444-64012-3.00025-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although highly prevalent, motor syndromes in psychiatry and motor side effects of psychopharmacologic agents remain understudied. Catatonia is a syndrome with specific motor abnormalities that can be seen in the context of a variety of psychiatric and somatic conditions. The neuroleptic malignant syndrome is a lethal variant, induced by antipsychotic drugs. Therefore, antipsychotics should be used with caution in the presence of catatonic signs. Antipsychotics and other dopamine-antagonist drugs can also cause motor side effects such as akathisia, (tardive) dyskinesia, and dystonia. These syndromes share a debilitating impact on the functioning and well-being of patients. To reduce the risk of inducing these side effects, a balanced and well-advised prescription of antipsychotics is of utmost importance. Clinicians should be able to recognize motor side effects and be knowledgeable of the different treatment modalities.
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Affiliation(s)
- Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium.
| | - Peter van Harten
- Research Department, GGz Centraal Innova, Amersfoort, and Department of Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Didi Rhebergen
- Department of Psychiatry and Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Ungvari GS, Gerevich J, Takács R, Gazdag G. Schizophrenia with prominent catatonic features: A selective review. Schizophr Res 2018; 200:77-84. [PMID: 28818505 DOI: 10.1016/j.schres.2017.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
A widely accepted consensus holds that a variety of motor symptoms subsumed under the term 'catatonia' have been an integral part of the symptomatology of schizophrenia since 1896, when Kraepelin proposed the concept of dementia praecox (schizophrenia). Until recently, psychiatric classifications included catatonic schizophrenia mainly through tradition, without compelling evidence of its validity as a schizophrenia subtype. This selective review briefly summarizes the history, psychopathology, demographic and epidemiological data, and treatment options for schizophrenia with prominent catatonic features. Although most catatonic signs and symptoms are easy to observe and measure, the lack of conceptual clarity of catatonia and consensus about the threshold and criteria for its diagnosis have hampered our understanding of how catatonia contributes to the pathophysiology of schizophrenic psychoses. Diverse study samples and methodologies have further hindered research on schizophrenia with prominent catatonic features. A focus on the motor aspects of broadly defined schizophrenia using modern methods of detecting and quantifying catatonic signs and symptoms coupled with sophisticated neuroimaging techniques offers a new approach to research in this long-overlooked field.
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Affiliation(s)
- Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre, 200 Cambridge Street, Perth 6014, Australia
| | - Jozsef Gerevich
- Addiction Research Institute, Remete u 12, Budapest, Hungary.
| | - Rozália Takács
- Psychiatric Outpatient Service, Toth Ilona Medical Service, Csiko setany 9, 1214 Budapest, Hungary; School of Doctoral Studies, Semmelweis University, Ulloi ut 85, 1085 Budapest, Hungary
| | - Gábor Gazdag
- 1st Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc Hospital, Koves ut 1, 1204 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa u 6, Budapest, Hungary.
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Beach SR, Gomez-Bernal F, Huffman JC, Fricchione GL. Alternative treatment strategies for catatonia: A systematic review. Gen Hosp Psychiatry 2017; 48:1-19. [PMID: 28917389 DOI: 10.1016/j.genhosppsych.2017.06.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Catatonia is a commonly encountered syndrome, affecting 10-20% of various psychiatric populations and carrying significant medical co-morbidities. However, there are few established alternative treatment strategies when benzodiazepines are ineffective and electroconvulsive therapy is unavailable. OBJECTIVE The authors systematically review evidence for alternative treatment strategies for catatonia using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. METHOD The authors conducted a search of PubMed database from 1983 to August 2016 to identify articles. Eligible reports presented cases involving treatment of catatonia using modalities other than benzodiazepines or electroconvulsive therapy. RESULTS The authors identified 72 articles, comprising 98 individual cases. N-methyl-d-aspartate-receptor antagonists, anti-epileptic drugs, and atypical antipsychotic agents appeared to have the largest number of reports supporting their effectiveness and safety in treating catatonia patients. CONCLUSIONS Based on the case report literature, the authors propose an updated algorithm for catatonia treatment in cases where benzodiazepines fail and electroconvulsive therapy is not available.
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Affiliation(s)
- Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | | | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Gregory L Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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9
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Breckpot J, Vercruyssen M, Weyts E, Vandevoort S, D'Haenens G, Van Buggenhout G, Leempoels L, Brischoux-Boucher E, Van Maldergem L, Renieri A, Mencarelli MA, D'Angelo C, Mericq V, Hoffer MJ, Tauber M, Molinas C, Castiglioni C, Brison N, Vermeesch JR, Danckaerts M, Sienaert P, Devriendt K, Vogels A. Copy number variation analysis in adults with catatonia confirms haploinsufficiency of SHANK3 as a predisposing factor. Eur J Med Genet 2016; 59:436-43. [PMID: 27519580 DOI: 10.1016/j.ejmg.2016.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/22/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catatonia is a motor dysregulation syndrome co-occurring with a variety of psychiatric and medical disorders. Response to treatment with benzodiazepines and electroconvulsive therapy suggests a neurobiological background. The genetic etiology however remains largely unexplored. Copy Number Variants (CNV), known to predispose to neurodevelopmental disorders, may play a role in the etiology of catatonia. METHODS This study is exploring the genetic field of catatonia through CNV analysis in a cohort of psychiatric patients featuring intellectual disability and catatonia. Fifteen adults admitted to a psychiatric inpatient unit and diagnosed with catatonia were selected for array Comparative Genomic Hybridization analysis at 200 kb resolution. We introduced a CNV interpretation algorithm to define detected CNVs as benign, unclassified, likely pathogenic or causal with regard to catatonia. RESULTS Co-morbid psychiatric diagnoses in these patients were autism, psychotic or mood disorders. Eight patients were found to carry rare CNVs, which could not be classified as benign, comprising 6 duplications and 2 deletions. Microdeletions on 22q13.3, considered causal for catatonia, were detected in 2 patients. Duplications on 16p11.2 and 22q11.2 were previously implicated in psychiatric disorders, but not in catatonia, and were therefore considered likely pathogenic. Driven by the identification of a rare 14q11.2 duplication in one catatonic patient, additional patients with overlapping duplications were gathered to delineate a novel susceptibility locus for intellectual disability and psychiatric disorders on 14q11.2, harboring the gene SUPT16H. Three remaining variants respectively on 2q36.1, 16p13.13 and 17p13.3 were considered variants of unknown significance. CONCLUSION The identification of catatonia-related copy number changes in this study, underscores the importance of genetic research in patients with catatonia. We confirmed that 22q13.3 deletions, affecting the gene SHANK3, predispose to catatonia, and we uncover 14q11.2 duplications as a novel susceptibility factor for intellectual and psychiatric disorders.
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Affiliation(s)
- Jeroen Breckpot
- Center for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Marieke Vercruyssen
- University Psychiatric Center KU Leuven, Catholic University of Leuven, Belgium
| | - Eddy Weyts
- St-Camillus Psychiatric Hospital, Bierbeek, Belgium
| | | | | | | | - Lore Leempoels
- University Psychiatric Center KU Leuven, Catholic University of Leuven, Belgium
| | | | | | - Alessandra Renieri
- Medical Genetics, University of Siena, Policlinico Le Scotte, Siena, Italy; Medical Genetics, Azienda University Hospital, Siena, Italy
| | | | - Carla D'Angelo
- Human Genome and Stem Cell Center, University of Sao Paulo, Sao Paulo, Brazil
| | - Veronica Mericq
- Institute of Maternal and Child Research, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mariette J Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maithé Tauber
- Endocrinology Unit, Children's Hospital, CHU Toulouse, Reference Center for Prader-Willi Syndrome, INSERM UMR 1043, Paul Sabatier University, Toulouse, France
| | - Catherine Molinas
- Endocrinology Unit, Children's Hospital, CHU Toulouse, Reference Center for Prader-Willi Syndrome, INSERM UMR 1043, Paul Sabatier University, Toulouse, France.
| | - Claudia Castiglioni
- Unit of Neurology, Department of Pediatric Neurology, Clínica las Condes, Santiago, Chile
| | - Nathalie Brison
- Center for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Joris R Vermeesch
- Center for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Marina Danckaerts
- University Psychiatric Center KU Leuven, Catholic University of Leuven, Belgium
| | - Pascal Sienaert
- University Psychiatric Center KU Leuven, Catholic University of Leuven, Belgium
| | | | - Annick Vogels
- Center for Human Genetics, Catholic University Leuven, Leuven, Belgium.
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