clozapine and Pneumonia--Viral

Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.

Topics: Antipsychotic Agents; Asian People; Clozapine; Coronavirus Infections; COVID-19; Drug Labeling; Humans; Pandemics; Pneumonia; Pneumonia, Viral; Psychiatry; Schizophrenia

The COVID-19 pandemic is a particularly relevant threat to mentally ill patients, and it constitutes a new challenge for health care providers. To the best of our knowledge, there is not any embracing published review about the use of psychotropic drugs during the COVID-19 pandemic.. Non-systematic literature review. A search in the PubMed database was performed, with the terms 'psychotropic drugs', 'COVID-19', 'psychiatry' and 'pandemic'. Consensus and clinical guidelines about psychotropic drugs and COVID-19 approach, published by scientific societies, governmental entities and drug regulatory agencies were included.. We present the recommendations about the use of psychotropic drugs during the COVID-19 pandemic, in the outpatient and inpatient settings. The treatment of affective bipolar disorder and schizophrenia have now added increased difficulties. Some psychotropic drugs interfere with the pathophysiology of the novel coronavirus infection and they could interact with the drugs used in the treatment of COVID-19. Some patients will need pharmacological interventions due to the presence of delirium. Smoking cessation changes the serum levels of some psychotropic drugs and may influence their use.. The COVID-19 pandemic has created new challenges in clinical practice. Psychiatric patients are a vulnerable population and often a careful clinical, laboratorial and electrocardiographic evaluation may be needed, particularly in those diagnosed with COVID-19. The regular treatment of mentally ill patients with COVID-19 presents increased complexity.. Introdução: A pandemia de COVID-19 constitui uma ameaça particularmente relevante para os portadores de doença mental e um novo desafio para os profissionais que os acompanham. Até à data, tanto quanto sabemos, não existe qualquer revisão abrangente publicada relativamente à utilização de fármacos psicotrópicos durante a pandemia COVID-19. Material e Métodos: Revisão não sistemática da literatura. A pesquisa na PubMed foi realizada com os termos ‘psychotropic drugs’, ‘COVID-19’, ‘psychiatry’ e ‘pandemic’. Foram incluídos os consensos e as normas publicadas pelas sociedades científicas, entidades governamentais e agências regulamentares de medicamentos. Resultados e Discussão: Apresentam-se recomendações relativamente à utilização de psicofármacos durante a pandemia COVID-19, em contexto de ambulatório e de internamento. O tratamento da perturbação afetiva bipolar e da esquizofrenia tem agora dificuldades acrescidas. Alguns psicofármacos interferem com os mecanismos fisiopatológicos envolvidos na infeção pelo novo coronavírus e têm interações com os fármacos utilizados no tratamento da COVID-19. Em doentes com COVID-19 e com delirium, a utilização de psicofármacos poderá ser necessária. A cessação tabágica altera os níveis séricos de alguns psicofármacos e pode condicionar a sua utilização. Conclusão: A pandemia de COVID-19 coloca novos desafios na prática clínica. Os doentes psiquiátricos constituem uma população vulnerável, sendo frequentemente necessária uma avaliação clínica, laboratorial e eletrocardiográfica cuidadosa, naqueles com o diagnóstico de COVID-19. Os doentes mentais com COVID-19 apresentam uma complexidade acrescida na gestão da sua terapêutica habitual.

Topics: Antiviral Agents; Benzodiazepines; Betacoronavirus; Bipolar Disorder; Body Temperature Regulation; Buprenorphine; Clozapine; Coronavirus Infections; COVID-19; Delayed-Action Preparations; Drug Interactions; Hospitalization; Humans; Lithium Compounds; Mental Disorders; Methadone; Narcotic Antagonists; Pandemics; Pneumonia, Viral; Psychotropic Drugs; SARS-CoV-2; Schizophrenia; Smoking Cessation Agents; Valproic Acid

Topics: Antipsychotic Agents; Betacoronavirus; Clinical Laboratory Techniques; Clozapine; Consensus; Coronavirus Infections; COVID-19; COVID-19 Testing; Humans; Neutropenia; Pandemics; Pneumonia, Viral; SARS-CoV-2; Schizophrenia

Topics: Agammaglobulinemia; Antipsychotic Agents; Betacoronavirus; Clozapine; Contraindications, Drug; Coronavirus Infections; COVID-19; Drug Monitoring; Drug Prescriptions; Humans; Pandemics; Parkinson Disease; Pneumonia, Aspiration; Pneumonia, Viral; Psychotic Disorders; SARS-CoV-2; Schizophrenia; Sialorrhea

Topics: Betacoronavirus; Clozapine; Coronavirus Infections; COVID-19; Delivery of Health Care; Evidence-Based Medicine; Humans; Mental Disorders; Mental Health; Pandemics; Pneumonia, Viral; SARS-CoV-2; Systematic Reviews as Topic; Vulnerable Populations

Topics: Antipsychotic Agents; Clozapine; Coronavirus Infections; COVID-19; Drug Monitoring; Humans; Intersectoral Collaboration; Pandemics; Pharmacists; Physicians; Pneumonia, Viral

Topics: Adult; Ambulatory Care Facilities; Antipsychotic Agents; Clozapine; Coronavirus Infections; COVID-19; Humans; Mental Health Services; Pandemics; Pneumonia, Viral; Schizophrenia

Topics: Anticonvulsants; Antipsychotic Agents; Betacoronavirus; Clozapine; Coronavirus Infections; COVID-19; Delayed-Action Preparations; Drug Resistance; Drug Therapy, Combination; Humans; Immunologic Factors; Lithium Carbonate; Male; Middle Aged; Paliperidone Palmitate; Pandemics; Pneumonia, Viral; Psychotic Disorders; SARS-CoV-2; Sialorrhea; Treatment Outcome; Valproic Acid

Topics: Adult; Antipsychotic Agents; Clozapine; Coronavirus Infections; COVID-19; Drug Monitoring; Female; Humans; India; Male; Pandemics; Patient Preference; Pneumonia, Viral; Schizophrenia; Telemedicine; Telephone

Topics: Betacoronavirus; Clozapine; Consensus; Coronavirus Infections; COVID-19; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2

Topics: Betacoronavirus; Clozapine; Coronavirus Infections; COVID-19; Humans; Pandemics; Pneumonia, Viral; SARS-CoV-2

Topics: Adult; Antipsychotic Agents; Clozapine; Coronavirus Infections; COVID-19; Fatal Outcome; Humans; Male; Pandemics; Pneumonia, Viral; Schizophrenia

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.

Topics: Antipsychotic Agents; Betacoronavirus; Clozapine; Coronavirus Infections; COVID-19; Diagnosis, Differential; Electroencephalography; Female; Humans; Middle Aged; Pandemics; Pneumonia, Viral; Psychotic Disorders; SARS-CoV-2; Status Epilepticus