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Mejri I, Ouali U, Gronholm PC, Zgueb Y, Ouertani A, Nacef F. "To fast or not to fast?" Ramadan and religiosity through the eyes of people with bipolar disorder: an exploratory study. Front Psychiatry 2023; 14:1270000. [PMID: 37908594 PMCID: PMC10613667 DOI: 10.3389/fpsyt.2023.1270000] [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: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Background The month of Ramadan, due to its changes in social rhythms, can seriously affect the course of bipolar disorder (BD). Therefore, psychiatrists sometimes find it necessary to discourage Ramadan practices, especially fasting, although taking part in this practice can give a sense of belonging and accomplishment to patients. Research on this subject is limited. Aim The aim of the present work was to explore: (i) religious practices with special attention to Ramadan before and after the onset of BD, (ii) the perceptions and behaviors related to not fasting during Ramadan in patients with BD and their families' attitudes, (iii) religiosity and self-stigmatization and their relationships with religious practices, and (iv) the doctor-patient relationship around fasting. Methods We conducted a retrospective, cross-sectional and descriptive study in clinically stabilized patients with BD in a public mental hospital and in a private psychiatric practice in Tunis, Tunisia. Socio-demographic and clinical data, as well as data related to general religious practices and Ramadan practices were collected using a self-established questionnaire. We assessed (i) religiosity of the patients with the Duke University Religion Index and (ii) self-stigma using the Internalized Stigma of Mental Illness scale. Results Our sample consisted of 118 patients of whom 65.3% were fasting regularly before BD onset. More than half had stopped this practice following BD onset. Of the patients who did not fast, 16% felt guilty about this and 4.9% reported receiving negative remarks from their surroundings. High self-stigma scores were observed in 11% of the patients. Self-stigma was associated significantly with negative perception of not fasting, negative remarks regarding not fasting and taking both meals at regular times during Ramadan. The decision whether to fast or not was taken without seeking medical advice in 71.2% of the sample, and 16.9% of the sample reported that their psychiatrist had spontaneously approached the issue of Ramadan fasting. Conclusion Religiosity and more specifically the practice of Ramadan remains an important point that should be considered when treating patients with psychiatric problems. It seems necessary that healthcare professionals should integrate the positive and the negative side of fasting into their reflections. Our results remain exploratory and encourage further work on the subject.
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Affiliation(s)
- Imen Mejri
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Fethi Nacef
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Fasting in mood disorders and its potential therapeutic aspects -narrative review. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Fasting is defined as a period of voluntary abstinence from eating food for religious, therapeutic or political reasons, which is associated with a reduction in the supply of sources (kilocalories) to the body. There are different types of fasting, including short, long or intermittent fasting. It has been shown that the use of different types of fasting can influence the occurrence of mood disorders. The aim of this review was to search for the relationship between the use of fasting and mood disorders and its potential use as a therapeutic method.
Material and method: The available literature was reviewed by searching the PubMed and Google Scholar databases using the following keywords: fasting, intermittent fasting, mood disorders, depression, Ramadan, for studies listed from database inception to November 2021.
Results: A review of the collected scientific articles indicates that the dietary restrictions, including both daily restriction of caloric consumption and the use of intermittent fasting (IF), has potentially numerous health benefits in the co-treatment of mental diseases. However, due to conflicting results, further clinical trials in mentally ill people should be conducted. It is worth remembering that among patients with mental illnesses there are somatically ill. IF in these people may require additional nutritional modifications or discontinuation of therapy.
Conclusions: Dietary restriction and fasting are promising methods in co-therapy of mood disorders treatment. However, implementing therapy needs earlier individual evaluation of their benefits and risk, the same as patient’s feasibility of implementing this type of intervention.
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Negm M, Bahaa A, Farrag A, Lithy RM, Badary HA, Essam M, Kamel S, Sakr M, Abd El Aaty W, Shamkh M, Basiony A, Dawoud I, Shehab H. Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study. BMC Gastroenterol 2022; 22:203. [PMID: 35462542 PMCID: PMC9036734 DOI: 10.1186/s12876-022-02272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Intermittent fasting (IF) during the month of Ramadan is part of the religious rituals of Muslims. The effect of intermittent fasting on disease activity in inflammatory bowel diseases (IBD) is still unknown. This is the first study to assess the effect of IF during Ramadan on inflammatory markers in patients diagnosed with IBD. The effects on clinical disease activity, quality of life, and levels of depression were also assessed. Methods Patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) who intended to observe Ramadan fasting were recruited. The following were assessed immediately before and at the end of Ramadan: Serum CRP and stool calprotectin, partial Mayo score, Harvey Bradshaw index (HBI), Simple IBD questionnaire (SIBDQ), and Hamilton depression scale questionnaire. Results 80 patients diagnosed with IBD were recruited (60 UC, 20 CD). Serum CRP and stool calprotectin did not show a significant change before vs after fasting (median CRP 0.53 vs 0.50, P value = 0.27, Calprotectin 163 vs 218 respectively, P value = 0.62). The partial Mayo score showed a significant rise after fasting (median 1 before vs 1 after fasting, mean: 1.79 vs 2.33 respectively, P value = 0.02). Harvey-Bradshaw index did not show a significant change after fasting (median 4 vs 5, P value = 0.4). Multiple linear regression revealed that older age and a higher baseline calprotectin were associated with a higher change in Mayo score after fasting (P value = 0.02 and P value = 0.01, respectively). No significant change was detected in SIBDQ or Hamilton depression scale scores. Conclusions In patients diagnosed with UC, IF during Ramadan was associated with worsening of clinical parameters, the effect was more pronounced in older patients and those with higher baseline calprotectin levels. However, IF during Ramadan was not associated with an adverse effect on objective inflammatory markers (CRP and calprotectin).
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Ben Ammar H, Ben Massoued R, Ben Hamadi A, Khelifa E, Hakiri A, El Hechmi Z. Hospitalizations in psychiatry during the month of Ramadan: A study at the Tunisian mental health hospital. Int J Soc Psychiatry 2022; 68:341-345. [PMID: 33455506 DOI: 10.1177/0020764020988888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Muslims fast each year during the Holy Month of Ramadan. This rite has major socio-cultural consequences. The circadian rhythms, energy expenditure, body temperature and biological clock are also influenced by Ramadan fasting. The impact of fasting on patients with mental disorders has been little studied. The aim of this study was to assess the number of hospitalizations in psychiatry during Ramadan compared to the other months of the lunar year. METHOD A cross-sectional and retrospective study was conducted at Razi hospital, the psychiatric hospital in Tunis. The following data over the five lunar years (1434-1438) was checked for: The monthly and the annual number of hospitalizations in the different departments of Razi mental health hospital in Tunis as well as the monthly and annual rates of different legal modalities of admissions. RESULTS An important decrease in the number of hospitalizations during Ramadan was observed each year followed by a constant increase during the following month.Ramadan was the only lunar month to have had a consistently below-average number of admissions. There has been a significant increase in the mean number of hospitalizations per month over the years. A general trend towards an increase in the proportion of enforced hospitalizations has been noted. CONCLUSION Ramadan stands out not only on a religious but also on a social level. Our results add support to the usefulness of research on mental health and Ramadan in the psychiatric community.
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Affiliation(s)
- Hanen Ben Ammar
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Rihab Ben Massoued
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Asma Ben Hamadi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Emira Khelifa
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Abir Hakiri
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Zouhaier El Hechmi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
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Mahmood A, Dar S, Dabhad A, Aksi B, Chowdhury TA. Advising patients with existing conditions about fasting during Ramadan. BMJ 2022; 376:e063613. [PMID: 35101897 DOI: 10.1136/bmj-2020-063613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ammad Mahmood
- Institute of Neurosciences and Psychology, University of Glasgow, Imaging Centre of Excellence, Queen Elizabeth University Hospital, Glasgow
| | - Sahira Dar
- NHS Greater Glasgow and Clyde Primary Care Division, Glasgow
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Hassan A, Merghany N, Ouchkat F, Regragui W, Kedah H, Hamdy SM, Abdel-Naseer M, Shehata HS, Shalaby NM, Kishk NA, Nada MAF, Hegazy MI, Farghaly M, Ahmed SM, Hussein M. Impact of Ramadan fasting on disease activity in patients with multiple sclerosis: a multicenter study. Nutr Neurosci 2021:1-10. [PMID: 34842062 DOI: 10.1080/1028415x.2021.2006955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The safety of Ramadan fasting for Muslim patients suffering from multiple sclerosis (MS) is still a matter of debate. This work aimed to study the clinical course of MS during Ramadan fasting and to clarify the predictors of relapses and symptoms exacerbation. METHODS This retrospective study included 153 Muslim patients with MS. Data related to the disease course before Ramadan were obtained from patients' files, whereas data related to the disease activity during Ramadan, were collected from patients over the two months following Ramadan. RESULTS Patients with MS who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant longer disease duration compared to those who did not experience (P < 0.001, <0.001, 0.01 respectively). Also, patients who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant higher expanded disability status scale (EDSS) compared to those who did not experience (P <0.001, <0.001,0.01, respectively). The occurrence of relapses, exacerbation of symptoms and development of new symptoms during Ramadan, were significantly higher in patients who experienced relapses in the preceding year compared to those who did not (P= 0.002, 0.002, 0.01, respectively). Binary logistic regression revealed that each score elevation of EDSS increased the odds of relapse during Ramadan by 1.02 (P-value = 0.04). Also, each month's increase in disease duration increased the odds of relapse during Ramadan by 1.87 (P-value = 0.046). CONCLUSION High EDSS and long disease duration are independent predictors of relapse during Ramadan.
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Affiliation(s)
- Amr Hassan
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla Merghany
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fatima Ouchkat
- Department of Neurology and Neurogenetics, Hospital of Specialties, University Mohammed V - Souissi Rabat, Rabat, Morocco
| | - Wafa Regragui
- Department of Neurology and Neurogenetics, Hospital of Specialties, University Mohammed V - Souissi Rabat, Rabat, Morocco
| | - Hanaa Kedah
- Neurology Department, Hera Hospital, Makkah, KSA
| | - Sherif M Hamdy
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maged Abdel-Naseer
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem S Shehata
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin M Shalaby
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nirmeen A Kishk
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona A F Nada
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed I Hegazy
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa Farghaly
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sandra M Ahmed
- Neurology Department-Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Hussein
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Ghram A, Ben Saad H, Briki W, Jiménez-Pavón D, Mansoor H, Moalla W, Akbari HA, Ghram A, Al-Mohannadi AS, Arena R, Lavie CJ. Ramadan Intermittent Fasting, Physical Activity, and COVID-19 Pandemic in Patients with Chronic Diseases. Am J Med 2021; 134:1189-1191. [PMID: 34051150 PMCID: PMC8149465 DOI: 10.1016/j.amjmed.2021.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Amine Ghram
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Cardiac Rehabilitation, Tehran Heart Center, Tehran University of Medical Sciences, Iran.
| | - Helmi Ben Saad
- Faculté de Médecine de Sousse, Hôpital Farhat HACHED de Sousse, Laboratoire de Recherche «Insuffisance Cardiaque» (LR12SP09), Université de Sousse, Sousse, Tunisia
| | - Walid Briki
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - David Jiménez-Pavón
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Hend Mansoor
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Wassim Moalla
- LR19JS01 EM2S: Éducation, Motricité, Sport et Santé, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Hesam Addin Akbari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Iran
| | - Abdeljelil Ghram
- Laboratory of Epidemiology and Veterinary Microbiology, LR16IP03, Institute Pasteur of Tunis, Tunis El Manar University, Tunis-Belvedere, Tunisia
| | - Abdulla Saeed Al-Mohannadi
- World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, La
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Jahrami H, BaHammam AS, Haji EA, Bragazzi NL, Rakha I, Alsabbagh A, Nugraha B, Pasiakos SM. Ramadan Fasting Improves Body Composition without Exacerbating Depression in Males with Diagnosed Major Depressive Disorders. Nutrients 2021; 13:nu13082718. [PMID: 34444878 PMCID: PMC8398343 DOI: 10.3390/nu13082718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Ramadan fasting (RF) is a form of intermittent fasting that generally improves body composition and related metabolic profiles. Whether RF exacerbates depressive symptomatology in individuals diagnosed with major depressive disorder (MDD) is undetermined. Methods: 100 men, who lived in Bahrain and were between the ages of 18 and 64 years with an established diagnosis of MDD, participated in this 4-week study. Based on preference, participants were assigned to a fasting group (FG, n = 50) and a non-fasting group (NFG, n = 50). The FG engaged in fasting from 03:40 to 18:10 (dawn and dusk timings). Changes in depressive symptoms, body mass, body composition, and components of metabolic syndrome were measured. Results: There were no significant changes in depressive symptoms within the FG vs. NFG after controlling for baseline covariates: mean difference 0.49 (SE = 0.63), p = 0.43. No adverse effects were reported in either group. The FG experienced significant reductions in body mass, 1.87 kg, p = 0.001; body mass index, 0.69 kg/m2, p = 0.001; body fat, 0.87%, p = 0.001; body surface area, 0.03 m2, p = 0.001; and lean mass, 0.77 kg, p = 0.001. Conclusions: RF did not negatively affect depressive symptoms and improved body composition, suggesting short-term intermittent fasting may be a safe dietary practice for adult males with MDD.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
- Correspondence: (H.J.); (N.L.B.)
| | - Ahmed S. BaHammam
- University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, P.O. Box 225503, Riyadh 11324, Saudi Arabia;
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh 11324, Saudi Arabia
| | - Eman Ahmed Haji
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 323, Bahrain
| | - Nicola L. Bragazzi
- Laboratory for Industrial and Applied Mathematics, Departments and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Correspondence: (H.J.); (N.L.B.)
| | - Ihab Rakha
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
| | - Amani Alsabbagh
- Ministry of Health, Manama 410, Bahrain; (E.A.H.); (I.R.); (A.A.)
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hannover, Germany;
| | - Stefan M. Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA;
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Abstract
Ramadan is a religious month dedicated to prayer, fasting and feasting. Recently, there has been an increased interest among healthcare providers regarding possible health-related complications as a consequence of religious fasting such as that seen during Ramadan. In , a 34-year-old female patient with a diagnosis of schizoaffective disorder, depressive type, was admitted for inpatient hospitalization to an inpatient psychiatric hospital in Buffalo, New York. The earliest date of initial diagnosis is unclear; however, the patient reports an increase in symptoms during her early twenties. Upon admission, the patient was continued on haloperidol, lithium and fluphenazine decanoate which had been initiated prior to this admission. Medication administration and meal times were adjusted to accommodate her observance of Ramadan. Despite efforts to mitigate the potential impact, the patient complained of dizziness and weakness following initiation and titration of clozapine. Due to psychiatric exacerbation, inpatient hospitalization and continuous monitoring, clozapine titration occurred quickly. Upon admission, the patient's blood pressure was 137/85 mmHg, which decreased to a low of 87/58 mmHg as her clozapine dose was increased, leaving the patient requesting bedrest due to significant dizziness and weakness. On the 21st day of Ramadan, the patient broke her fast due to substantial adverse effects. Five days after breaking her fast, the patient's blood pressure increased and returned to baseline. Individuals participating in Ramadan tend to have disrupted sleep cycles, including nocturnal sleep reduction and broken sleep patterns, which can impact overall health. Additional health-related complications that have been reported include dehydration and changes in blood glucose, blood pressure, lipid panel, body weight and exacerbation of psychiatric symptoms. These adverse effects can result in serious complications in fasting individuals with acute medical and psychiatric illness. Clozapine was initiated and rapidly titrated during the patient's observance of Ramadan. She exhibited signs and symptoms of hypotension, which were also subjectively reported by the patient. The significant drop in blood pressure while fasting, and rapid increase once the fast was broken, confirm that medication changes implemented during religious fasting, such as that seen during Ramadan, can increase a patient's risk of serious adverse effects.
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