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1.
J Psychiatry Neurosci ; 46(2): E232-E237, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1127808

RESUMEN

Background: Monitoring of white cell counts during clozapine treatment leads to cessation of therapy if levels fall below predetermined values. Reductions in white cell counts, driven by lower levels of lymphocytes, have been observed with coronavirus disease 2019 (COVID-19). Neutropenia during COVID-19 has not been reported. We present data for 56 patients who were taking clozapine and had COVID-19. Methods: We included patients who were taking clozapine at the time they tested positive for COVID-19. We compared absolute neutrophil counts, lymphocyte counts and white cell counts between baseline and the first week of infection, and baseline and the second week of infection. Results: We observed reductions in absolute neutrophil counts (p = 0.005), lymphocyte counts (p = 0.003) and white cell counts (p < 0.001) between baseline and the first 7 days of COVID-19. All cell counts had returned to baseline levels by days 8 to 14. Six patients experienced neutropenia (absolute neutrophil counts < 2.0 × 109/L) and of those, 4 underwent mandatory cessation of clozapine. For 3 patients, clozapine treatment had been established for more than 6 months with no previous neutropenia, neutrophil levels returned to baseline within 2 weeks and no further neutropenia was observed on restarting treatment. Limitations: This was a retrospective chart review; larger cohorts are required. Clozapine plasma levels were largely not measured by clinicians. Conclusion: These data strongly suggest that mild neutropenia in the acute phase of COVID-19 in patients who are well established on clozapine is more likely to be a consequence of the virus than of clozapine treatment.


Asunto(s)
Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Neutropenia/etiología , Trastornos Psicóticos/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Femenino , Humanos , Recuento de Leucocitos , Leucopenia/etiología , Recuento de Linfocitos , Linfopenia/etiología , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Neutrófilos , Estudios Retrospectivos , Adulto Joven
2.
J Psychiatr Pract ; 27(2): 137-144, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1114930

RESUMEN

The widespread prevalence of coronavirus disease 2019 (COVID-19) means that inpatient psychiatric units will necessarily manage patients who have COVID-19 that is comorbid with acute psychiatric symptoms. We report a case of recurrence of respiratory symptoms and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) testing in a patient on an inpatient psychiatric unit occurring 42 days after the initial positive SARS-CoV-2 RT-PCR test, 38 days after initial symptom resolution, and 30 days after the first of 3 negative SARS-CoV-2 RT-PCR tests. Over the course of the admission, the patient was safely initiated on clozapine. Recent literature on COVID-19's potential recurrence and neuropsychiatric effects is reviewed and implications for the management of COVID-19 on inpatient psychiatric units are discussed. In the era of COVID-19 and our still-developing understanding of this illness, psychiatrists' role as advocates and collaborators in our patients' physical health care has become even more critical.


Asunto(s)
Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/tratamiento farmacológico , Adulto , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , /psicología , Clozapina , Trastorno Depresivo Mayor/diagnóstico , Hospitales Psiquiátricos , Humanos , Pacientes Internos/psicología , Masculino , Mirtazapina/uso terapéutico , Trastornos Psicóticos/diagnóstico , Recurrencia , Sertralina/uso terapéutico , Intento de Suicidio
3.
J Psychiatr Pract ; 27(2): 131-136, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1114929

RESUMEN

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by the Severe Acute Respiratory Syndrome 2 Coronavirus (SARS-2-CoV). Although most prominently associated with pulmonary manifestations, COVID-19 is increasingly implicated in neuropsychiatric complications, including delirium and psychosis. There is a potential causal link between COVID-19 infection and psychotic symptoms; however, case reports to date have been incomplete, as the patients described had known psychiatric histories or other plausible medical causes for altered mental status. We present a longitudinal case of COVID-19 psychosis in a patient who underwent comprehensive diagnostic evaluation. This case is a contribution to the inchoate characterization of neuropsychiatric manifestations of COVID-19 infection. CASE REPORT: We present a case of late-onset psychosis in a middle-aged man with no psychiatric history who tested positive for COVID-19 on admission following a recently resolved upper respiratory illness. His acute presentation-characterized by delusions, hallucinations, and disorganized thought and behavior, for which he required inpatient medical admission and subsequent inpatient psychiatric hospitalization-was successfully treated. During his hospitalization, he underwent comprehensive medical and neurological workup (including neuroimaging; electroencephalography; and serum and cerebrospinal fluid testing) that was grossly unremarkable. DISCUSSION: Despite myriad potential causes of the patient's psychosis, this patient's diagnostic workup was largely unrevealing, apart from his nasopharyngeal SARS-2-CoV reverse transcriptase polymerase chain reaction assay. As such, psychosis secondary to COVID-19 infection emerged as the presumptive diagnosis.


Asunto(s)
/complicaciones , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/psicología , Enfermedad Aguda , Antipsicóticos/uso terapéutico , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/uso terapéutico
4.
Psychopharmacology (Berl) ; 238(2): 329-340, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-1012205

RESUMEN

RATIONALE: Management of anxiety, delirium, and agitation cannot be neglected in coronavirus disease (COVID-19). Antipsychotics are usually used for the pharmacological management of delirium, and confusion and behavioral disturbances. The concurrent use of treatments for COVID-19 and antipsychotics should consider eventual drug-drug interactions OBJECTIVE: To systematically review evidence-based available on drug-drug interactions between COVID-19 treatments and antipsychotics. EVIDENCE REVIEW: Three databases were consulted: Lexicomp® Drug Interactions, Micromedex® Solutions Drugs Interactions, and Liverpool© Drug Interaction Group for COVID-19 therapies. To acquire more information on QT prolongation and Torsade de Pointes (TdP), the CredibleMeds® QTDrugs List was searched. The authors made a recommendation agreed to by consensus. Additionally, a systematic review of drug-drug interactions between antipsychotics and COVID-19 treatment was conducted. RESULTS: The main interactions between COVID-19 drugs and antipsychotics are the risk of QT-prolongation and TdP, and cytochromes P450 interactions. Remdesivir, baricinitib, and anakinra can be used concomitantly with antipsychotics without risk of drug-drug interaction (except for hematological risk with clozapine and baricinitib). Favipiravir only needs caution with chlorpromazine and quetiapine. Tocilizumab is rather safe to use in combination with antipsychotics. The most demanding COVID-19 treatments for coadministration with antipsychotics are chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir because of the risk of QT prolongation and TdP and cytochromes interactions. The systematic review provides highly probable drug interaction between lopinavir/ritonavir plus quetiapine and ritonavir/indinavir plus risperidone. CONCLUSIONS: Clinicians prescribing antipsychotics should be aware of the likely risk of drug-drug interaction with COVID-19 medication and may benefit from taking into account present recommendations of use to preserve patient safety.


Asunto(s)
Antipsicóticos/efectos adversos , Antivirales/efectos adversos , /tratamiento farmacológico , Antipsicóticos/uso terapéutico , Antivirales/uso terapéutico , Sistema Enzimático del Citocromo P-450 , Interacciones Farmacológicas , Humanos , Síndrome de QT Prolongado/inducido químicamente , Torsades de Pointes/inducido químicamente
5.
Biomed Pharmacother ; 135: 111200, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1002355

RESUMEN

The recent outbreak of the corona virus disease (COVID-19) has had major global impact. The relationship between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and psychiatric diseases is of great concern, with an evident link between corona virus infections and various central and peripheral nervous system manifestations. Unmitigated neuro-inflammation has been noted to underlie not only the severe respiratory complications of the disease but is also present in a range of neuro-psychiatric illnesses. Several neurological and psychiatric disorders are characterized by immune-inflammatory states, while treatments for these disorders have distinct anti-inflammatory properties and effects. With inflammation being a common contributing factor in SARS-CoV-2, as well as psychiatric disorders, treatment of either condition may affect disease progression of the other or alter response to pharmacological treatment. In this review, we elucidate how viral infections could affect pre-existing psychiatric conditions and how pharmacological treatments of these conditions may affect overall progress and outcome in the treatment of SARS-CoV-2. We address whether any treatment-induced benefits and potential adverse effects may ultimately affect the overall treatment approach, considering the underlying dysregulated neuro-inflammatory processes and potential drug interactions. Finally, we suggest adjunctive treatment options for SARS-CoV-2-associated neuro-psychiatric symptoms.


Asunto(s)
Antiinflamatorios/uso terapéutico , Antipsicóticos/uso terapéutico , /epidemiología , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Antiinflamatorios/farmacología , Antipsicóticos/farmacología , Humanos , Mediadores de Inflamación/antagonistas & inhibidores , /fisiología
7.
Eur J Pharmacol ; 887: 173553, 2020 Nov 15.
Artículo en Inglés | MEDLINE | ID: covidwho-764566

RESUMEN

In 2020 the whole world focused on antivirus drugs towards SARS-CoV-2. Most of the researchers focused on drugs used in other viral infections or malaria. We have not seen such mobilization towards one topic in this century. The whole situation makes clear that progress needs to be made in antiviral drug development. The first step to do it is to characterize the potential antiviral activity of new or already existed drugs on the market. Phenothiazines are antipsychotic agents used previously as antiseptics, anthelminthics, and antimalarials. Up to date, they are tested for a number of other disorders including the broad spectrum of viruses. The goal of this paper was to summarize the current literature on activity toward RNA-viruses of such drugs like chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine. We identified 49 papers, where the use of the phenothiazines for 23 viruses from different families were tested. Chlorpromazine, fluphenazine, perphenazine, prochlorperazine, and thioridazine possess anti-viral activity towards different types of viruses. These drugs inhibit clathrin-dependent endocytosis, cell-cell fusion, infection, replication of the virus, decrease viral invasion as well as suppress entry into the host cells. Additionally, since the drugs display activity at nontoxic concentrations they have therapeutic potential for some viruses, still, further research on animal and human subjects are needed in this field to verify cell base research.


Asunto(s)
Antipsicóticos/farmacología , Antivirales/farmacología , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Fenotiazinas/farmacología , Neumonía Viral/tratamiento farmacológico , Virus ARN/efectos de los fármacos , Animales , Antipsicóticos/uso terapéutico , Antivirales/uso terapéutico , Clorpromazina/farmacología , Clorpromazina/uso terapéutico , Flufenazina/farmacología , Flufenazina/uso terapéutico , Humanos , Pandemias , Perfenazina/farmacología , Perfenazina/uso terapéutico , Fenotiazinas/uso terapéutico , Proclorperazina/farmacología , Proclorperazina/uso terapéutico , Tioridazina/farmacología , Tioridazina/uso terapéutico
8.
Psychosomatics ; 61(6): 585-596, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-726823

RESUMEN

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.


Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Encefalopatías/fisiopatología , Infecciones por Coronavirus/fisiopatología , Delirio/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Neumonía Viral/fisiopatología , Betacoronavirus , Encefalopatías/psicología , Depresores del Sistema Nervioso Central/uso terapéutico , Infecciones por Coronavirus/psicología , Delirio/fisiopatología , Delirio/psicología , Moduladores del GABA/uso terapéutico , Humanos , Lorazepam/uso terapéutico , Melatonina/uso terapéutico , Pandemias , Neumonía Viral/psicología , Guías de Práctica Clínica como Asunto
9.
J Affect Disord ; 277: 337-340, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: covidwho-722855

RESUMEN

BACKGROUND: In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT: Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION: This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION: This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.


Asunto(s)
Trastorno Bipolar/etiología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Anticuerpos Antivirales/líquido cefalorraquídeo , Antipsicóticos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Trastorno Bipolar/líquido cefalorraquídeo , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/tratamiento farmacológico , Encéfalo/diagnóstico por imagen , Dolor en el Pecho , China , Técnicas de Laboratorio Clínico , Cobicistat/uso terapéutico , Infecciones por Coronavirus/líquido cefalorraquídeo , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Darunavir/uso terapéutico , Disnea , Fiebre , Glucocorticoides/uso terapéutico , Humanos , Indoles/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Moxifloxacino/uso terapéutico , Olanzapina/uso terapéutico , Pandemias , Faringitis , Neumonía Viral/líquido cefalorraquídeo , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
10.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artículo en Inglés | MEDLINE | ID: covidwho-714270

RESUMEN

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/psicología , Neumonía Viral/complicaciones , Neumonía Viral/psicología , Trastornos Psicóticos/etiología , Trastornos Psicóticos/psicología , Adulto , Antipsicóticos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Pandemias , Trastornos Psicóticos/tratamiento farmacológico
12.
J Affect Disord ; 274: 1062-1067, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-629905

RESUMEN

BACKGROUND: The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. METHODS: We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTERED RECOMMENDATIONS: Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. LIMITATIONS: Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. CONCLUSIONS: Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pacientes Internos/psicología , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Neumonía Viral/complicaciones , Derivación y Consulta , Anciano , Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Pandemias , Neumonía Viral/psicología , Psiquiatría
13.
Psychosomatics ; 61(5): 544-550, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-616923

Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/terapia , Delirio/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Neumonía Viral/terapia , Agitación Psicomotora/tratamiento farmacológico , Fármacos Inductores del Sueño/uso terapéutico , Anciano , Analgésicos Opioides/efectos adversos , Azepinas/uso terapéutico , Betacoronavirus , Depresores del Sistema Nervioso Central/uso terapéutico , Clordiazepóxido/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Delirio/etiología , Delirio/fisiopatología , Delirio/psicología , Dexmedetomidina/efectos adversos , Femenino , Guanfacina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Hidromorfona/efectos adversos , Unidades de Cuidados Intensivos , Ketamina/efectos adversos , Melatonina/uso terapéutico , Midazolam/efectos adversos , Oxicodona/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Propofol/efectos adversos , Agitación Psicomotora/etiología , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/psicología , Respiración Artificial , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/etiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Traqueostomía , Triazoles/uso terapéutico , Ácido Valproico/uso terapéutico
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