Clinical Psychopharmacology and Neuroscience最新文献

{"title":"Asian Subgroup Analysis of the REMISSIO Study: A Long-Term Efficacy and Safety Study of Paliperidone Palmitate 3-month Formulation in Patients with Stable Schizophrenia in a Naturalistic Clinical Setting.","authors":"Young-Chul Chung,&nbsp;Yen Kuang Yang,&nbsp;Ahmad Hatim Sulaiman,&nbsp;Paul Bergmans,&nbsp;Wilson Tan","doi":"10.9758/cpn.2022.20.3.427","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.427","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term efficacy and safety of three-monthly paliperidone palmitate (PP3M) in Asian patients with stable schizophrenia in a naturalistic setting.</p><p><strong>Methods: </strong>Asian patients recruited between May 2016 and March 2018 from the prospective, single-arm, non-randomized, open-label, multi-national REMISSIO study were analyzed. Patients received PP3M over 12 months following ≥ 4 months of treatment with one-monthly paliperidone palmitate. The primary efficacy endpoint was the proportion of patients who achieved symptomatic remission. Other endpoints were changes in Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) total scores, hospitalization rates, and safety.</p><p><strong>Results: </strong>A total of 71 patients (23.3%) were Asian (South Korea: 33, Malaysia: 21, Taiwan: 17); 95.8% of patients completed the study. At LOCF, 71% of Asian patients achieved symptomatic remission compared to the overall population (n = 172/303, 56.8%). Improvements in mean (standard deviation) PANSS and PSP total scores from baseline to LOCF in Asian patients and overall population were clinically significant. A lower proportion of Asian patients had ≥ 1 psychiatric hospitalization after PP3M treatment (n = 1/70, 1.4%) than during the 12 months before (n = 12/70, 17.1%); compared with patients in the overall population after (n = 8/303, 2.6%) and before PP3M treatment (n = 37/303, 12.2%). The overall incidence of treatment-emergent adverse events across Asian patients was 62.9% compared to 53.1% in the overall population. Safety findings were consistent with the known safety profile of PP3M.</p><p><strong>Conclusion: </strong>Our findings confirm existing evidence on the efficacy and tolerability of PP3M in Asian patients with stable schizophrenia over 12 months of treatment.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"427-439"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2a/5f/cpn-20-3-427.PMC9329113.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Antipsychotic Drugs by Medication Possession Ratio for Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A Retrospective Cohort Study.","authors":"Sung Joon Cho,&nbsp;Jungmee Kim,&nbsp;Jin Yong Lee,&nbsp;Jee Hoon Sohn","doi":"10.9758/cpn.2022.20.3.491","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.491","url":null,"abstract":"<p><strong>Objective: </strong>Pharmacotherapy is considered as an essential element in the treatment of psychotic disorders including schizophrenia. Discontinuation of antipsychotic drugs increases medical use and economic burden. Therefore, maintenance of medication is essential to reduce the social burden caused by schizophrenia and schizophrenia similar psychosis (SSP), and hence, it is important to investigate the rate at which pharmacotherapy is maintained. Therefore, this study aimed to examine the current status of drug compliance using national health insurance data.</p><p><strong>Methods: </strong>This was a retrospective cohort study, which analyzed data from the nationwide insurance claims database. A total of 343,134 patients who were newly diagnosed with schizophrenia and SSP during 2011-2015. The adherence to antipsychotic drugs was assessed by medication possession ratio (MPR) and the risk factors of poor adherence were defined as MPR < 40%.</p><p><strong>Results: </strong>The average of the MPRs was 45.8%, and the proportion of patients with less than 40% of MPR was 50.8%. It was found that female patients, the experience of \"general hospital outpatient,\" \"psychiatric hospital admission,\" general hospital admission,\" and patients receiving \"health insurance\" showed high risk of having statistically significant low MPR (< 40%).</p><p><strong>Conclusion: </strong>In this study, the drug adherence of schizophrenia and SSP patients currently under treatment, as estimated by MPR, was very low. However, it was also found that the MPR was high among patients receiving medical aid, with less medical expenses. Thus, it is possible to consider an institutional mechanism in which schizophrenia and SSP patients can be treated with less economic burden.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"491-497"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/6f/cpn-20-3-491.PMC9329107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Loudness Dependence of Auditory Evoked Potentials is associated with the Symptom Severity and Treatment in Boys with Attention Deficit Hyperactivity Disorder.","authors":"Eun Jin Park,&nbsp;Young-Min Park,&nbsp;Seung-Hwan Lee,&nbsp;Bongseog Kim","doi":"10.9758/cpn.2022.20.3.514","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.514","url":null,"abstract":"<p><strong>Objective: </strong>The loudness dependence of the auditory evoked potential (LDAEP) is associated with central serotonergic neurotransmission. Recent studies have proposed that LDAEP is also influenced by dopaminergic activity. Evidence shows attention deficit hyperactivity disorder (ADHD) symptoms are associated with dopamine dysfunction. This study aimed to evaluate the relation between ADHD symptoms and LDAEP, as well as medication-mediated changes of LDAEP.</p><p><strong>Methods: </strong>A total of 38 male children (6-12 years old) with ADHD were analyzed in this study. Symptom severity was assessed using the ADHD rating scale (ARS) and the continuous performance test. To determine LDAEP, the auditory event-related potential was evaluated before medication. Changes in LDAEP were measured after 12 weeks of treatment with methylphenidate.</p><p><strong>Results: </strong>The subjects had a mean age of 9.24 ± 1.74 years with an average IQ of 109.4 ± 13.8. Before pharmacological treatment with methylphenidate, LDAEP was positively associated with the ARS score after adjusting for age and IQ (r = 0.592, <i>p</i> = 0.005). LDAEP was correlated with inattention (r = 0.522, <i>p</i> = 0.015) and hyperactivity-impulsivity (r = 0.6, <i>p</i> = 0.004). However, the LDAEP of 15 subjects decreased following methylphenidate treatment (Z = -1.988, <i>p</i> = 0.047).</p><p><strong>Conclusion: </strong>In boys with ADHD, LDAEP appears to be associated with symptom severity. LDAEP showed a significant association with impulsivity and inattention. Importantly, LDAEP was shown to decrease after drug treatment. Our findings support the utility of LDAEP as a noninvasive and clinically useful method to assess symptom severity in children with ADHD.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"514-525"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/e9/cpn-20-3-514.PMC9329111.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haloperidol and Other Antipsychotics Exposure before Endometrial Cancer Diagnosis: A Population-based Case-control Study.","authors":"Wei-Ling Chen,&nbsp;Srinivasan Nithiyanantham,&nbsp;Yan-Chiao Mao,&nbsp;Chih-Hsin Muo,&nbsp;Chih-Pin Chuu,&nbsp;Shih-Ping Liu,&nbsp;Min-Wei Huang,&nbsp;Kuan-Pin Su","doi":"10.9758/cpn.2022.20.3.526","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.526","url":null,"abstract":"<p><strong>Objective: </strong>Endometrial cancer is the most common malignancy of the female genital tract worldwide, and the associated relationship between endometrial cancer formation and various antipsychotics need to be confirmed.</p><p><strong>Methods: </strong>We conducted a case-control study by using data from Taiwan National Health Insurance Research Database to compare individual antipsychotic exposure between females with and without endometrial cancer. Among 14,079,089 females in the 12-year population-based national dataset, 9,502 females with endometrial cancer were identified. Their medical records of exposure to antipsychotics, including quetiapine, haloperidol, risperidone, olanzapine, amisulpride, clozapine, and aripiprazole, for up to 3 years before endometrial cancer diagnosis were reviewed. Daily dosage and cumulative exposure days were analyzed in the risky antipsychotic users. Additionally, the subsequent 5-year mortality rate of endometrial cancer among users of the risky antipsychotic were also analyzed.</p><p><strong>Results: </strong>Among endometrial cancer patients, the proportion of those who have used haloperidol before being diagnosed with endometrial cancer is significantly higher than other antipsychotic users. The significant odds ratio (OR) and a 95% confidence interval of 1.75 (1.31-2.34) were noted. Furthermore, haloperidol users were associated with a significantly higher 5-year mortality rate after getting endometrial cancer than non-users.</p><p><strong>Conclusion: </strong>There is a high correlation between the use of haloperidol and endometrial cancer formation. However, the underlying pathological biomechanisms require additional investigations.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"526-535"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/d6/cpn-20-3-526.PMC9329120.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amisulpride Augmentation in Schizophrenia Patients with Poor Response to Olanzapine: A 4-week, Randomized, Rater-Blind, Controlled, Pilot Study.","authors":"Young Sup Woo,&nbsp;Sung-Yong Park,&nbsp;Bo-Hyun Yoon,&nbsp;Won-Seok Choi,&nbsp;Sheng-Min Wang,&nbsp;Won-Myong Bahk","doi":"10.9758/cpn.2022.20.3.567","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.567","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy.</p><p><strong>Methods: </strong>The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks.</p><p><strong>Results: </strong>The changes in PANSS total score and PANSS-positive subscale score were significantly different (<i>p</i> < 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant.</p><p><strong>Conclusion: </strong>AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"567-572"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/7c/cpn-20-3-567.PMC9329105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations of Power Spectral Density in Salience Network during Thought-action Fusion Induction Paradigm in Obsessive-compulsive Disorder.","authors":"Sang Won Lee,&nbsp;Eunji Kim,&nbsp;Tae Yang Jang,&nbsp;Heajung Choi,&nbsp;Seungho Kim,&nbsp;Huijin Song,&nbsp;Moon Jung Hwang,&nbsp;Yongmin Chang,&nbsp;Seung Jae Lee","doi":"10.9758/cpn.2022.20.3.415","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.415","url":null,"abstract":"<p><strong>Objective: </strong>Recent studies highlighted the triple-network model which illustrated the interactions among three large-scale networks including salience network (SN). The functional magnetic resonance imaging used in this study was designed to investigate the characteristics of three large-scale networks associated with the thought-action fusion (TAF) in patients with obsessive-compulsive disorder (OCD) using power spectral density (PSD) analysis.</p><p><strong>Methods: </strong>This study included 32 OCD patients and 38 age-matched healthy controls (HC). The TAF task was modified from the experiment of Rassin. PSD from time courses in large-scale networks of each subject was measured to compare between the groups for both TAF and resting state.</p><p><strong>Results: </strong>In SN, OCD reported lower power in the low-frequency domain of SN compared to HC using the two-sample t test during the TAF task (t = -2.395, p = 0.019) but not in the resting state. The PSD in the low-frequency domain of the SN had a significant negative correlation with state score in the guilty inventory (r = -0.361, p = 0.042) in OCD patients.</p><p><strong>Conclusion: </strong>This study suggests that OCD patients showed reduced SN power which can be prominent in a certain situation, such as TAF. In addition, the PSD alterations in SN cause difficulty in processing ambiguous emotional cues in social situations, and the difficulty can be connected with a negative feeling (e.g., guilt).</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"415-426"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/51/cpn-20-3-415.PMC9329118.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Comorbidities in Adults with DiGeorge Syndrome.","authors":"Hiren Patel,&nbsp;Ramu Vadukapuram,&nbsp;Zeeshan Mansuri,&nbsp;Chintan Trivedi,&nbsp;Kanwarjeet Singh Brar,&nbsp;Uzma Beg,&nbsp;Jigar Patel,&nbsp;Aalamgeer Ibrahim,&nbsp;Muhammad Khalid Zafar","doi":"10.9758/cpn.2022.20.3.498","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.498","url":null,"abstract":"<p><strong>Objective: </strong>DiGeorge Syndrome (DGS) is a common multisystem disorder associated with deletions on chromosome 22q11.2. Our objective is to evaluate the psychiatric comorbidities and demographics of patients suffering from DGS in a nationally representative dataset on inpatient hospitalizations.</p><p><strong>Methods: </strong>The Nationwide Inpatient Sample for the year 2005-2017 was used for this study. Data on patients with DiGeorge syndrome were collected by using the International Classification of Diseases code. Univariate and multi- variate logistic regression analysis was performed.</p><p><strong>Results: </strong>In our study, the average age was 30.4 years (n = 6,563), with 59.9% male, and 61.8% of patients were white. There was a high prevalence of mood disorders (24.7%) and anxiety disorders (16.4%), followed by schizo- phrenia and other psychotic condition (14.0%). In patients with mood disorders, 8% had Major Depressive Disorder, and 7% had bipolar depression. Overall composite of psychiatric comorbidities was present in 2,959 (45.1%) of patients. The mean length of stay was 6.58 days, and 77% of patients had routine discharge to home. In the adjusted analysis, the average length of stay was 8.6 days vs. 6.7 days (p < 0.001) in patients with and without psychiatry comorbidities. In comparison to routine discharge, patients with psychiatry comorbidities were more likely to be discharged to other healthcare facilities (odds ratio [OR]: 1.28, p < 0.001) and discharged against medical advice (OR: 3.45, p < 0.001).</p><p><strong>Conclusion: </strong>Patients with DGS have worse outcomes with a higher rate of discharge to other healthcare facilities and a higher rate of being discharged against medical advice. Further large scale randomize studies are indicated.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"498-503"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/15/cpn-20-3-498.PMC9329110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cumulative Effect of Antipsychotic Usage on Mortality in Schizophrenia: A Nationwide Population-based Cohort Study in Korea.","authors":"Gyurin Kim,&nbsp;Soo Jung Rim,&nbsp;Minkyung Jo,&nbsp;Min Geu Lee,&nbsp;Se Jin Park,&nbsp;Subin Park","doi":"10.9758/cpn.2022.20.3.573","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.573","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the cumulative effect of antipsychotics at different dosages on mortality in patients with schizophrenia.</p><p><strong>Methods: </strong>We analyzed data from the Korean National Health Insurance System-National Sample Cohort covering the 2002-2013 period. We used Cox regression analysis to calculate hazard ratios for mortality risks according to cumulative antipsychotic exposure levels (low, moderate, and high).</p><p><strong>Results: </strong>Our analyses revealed no significant association between antipsychotic exposure and mortality (either all-cause or cause-specific) in patients with schizophrenia.</p><p><strong>Conclusion: </strong>Our results imply that the excess mortality of patients with schizophrenia is attributable to factors other than antipsychotic usage.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"573-577"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/8e/cpn-20-3-573.PMC9329102.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40634459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Application Value of <i>Lactobacillus Plantarum</i> PS128 in Patients with Anxiety Disorders.","authors":"Xiaojuan Meng,&nbsp;Yajie Gao,&nbsp;Hang Qi,&nbsp;Yongyan Ding,&nbsp;Yaqing Sun","doi":"10.9758/cpn.2022.20.3.560","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.560","url":null,"abstract":"<p><strong>Objective: </strong>PS128 is a novel psycho biotic strain, it has been reported to play an important role in neuropsychiatric disorders. This study investigated the clinical effect of PS128 supplementation on patients with anxiety.</p><p><strong>Methods: </strong>A total of 200 patients with anxiety were recruited, and divided into two groups (n = 100/group). The control group received oral treatment with citalopram, and the PS128 group received PS128 capsules based on citalopram treatment. Hamilton Anxiety Scale (HAMA) and Self-Rating Anxiety Scale (SAS) were used to evaluate the anxiety levels. After 2 months of continuous administration, clinical efficacy was evaluated according to HAMA score.</p><p><strong>Results: </strong>There was no significant difference in HAMA and SAS scores between the two groups before treatment. With the treatment prolonged, the HAMA and SAS score decreased gradually in both control and PS128 groups, and the decrease rate of PS128 group was significantly greater than that of the control group. The clinical effective rates of PS128 group were higher than those in the control group, high levels of clinical cure rate were also detected in the PS128 group. Compared with the control group (22%), the incidence of adverse reactions was significantly reduced for patients in the PS128 group (4%).</p><p><strong>Conclusion: </strong>The treatment effect of citalopram combined with PS128 against anxiety is satisfactory clinically. It can greatly improve the anxiety symptoms of patients, increase the cure rate, reduce adverse reactions.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"560-566"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/47/cpn-20-3-560.PMC9329101.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Embolism during a Retrial of Low-dose Clozapine.","authors":"Gregg Alan Robbins-Welty,&nbsp;Shannon Coats,&nbsp;Andrew N Tuck,&nbsp;Bryan K Lao,&nbsp;Zachary Lane","doi":"10.9758/cpn.2022.20.3.578","DOIUrl":"https://doi.org/10.9758/cpn.2022.20.3.578","url":null,"abstract":"<p><p>Pulmonary emboli (PE) are increasingly recognized as an adverse effect of clozapine. However, little is known about the characteristics or mechanisms of clozapine-associated PE. We present a case of a 34-year-old with treatment-refractory schizophrenia who developed rhabdomyolysis during his first clozapine trial. During re-trial on a lower dose than his initial trial, the patient developed chest pain that he attributed to \"pacemakers.\" The pleuritic description and associated tachycardia prompted medical workup and the patient was ultimately diagnosed with a clozapine-associated PE. The patient's only risk factors for PE were obesity and tobacco use, while his hypercoagulability workup was unrevealing. Clozapine use was continued at a lower dose following these adverse effects given inefficacy of other agents in managing the patient's psychotic symptoms. The patient experienced significant relief of psychotic symptoms with continued clozapine therapy and a course of electroconvulsive therapy. The patient's presentation was unusual in that it occurred during a retrial of clozapine, after the initial trial was stopped when he developed rhabdomyolysis. This case demonstrates the importance of maintaining vigilance for PE in patients on clozapine as well as not dismissing somatic complaints in patients experiencing psychosis. Additionally, given his history rhabdomyolysis, an uncommon adverse effect of clozapine, the development of a second uncommon adverse effect (PE) raises the question of whether these events may be associated.</p>","PeriodicalId":10420,"journal":{"name":"Clinical Psychopharmacology and Neuroscience","volume":"20 3","pages":"578-580"},"PeriodicalIF":3.2,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/ec/cpn-20-3-578.PMC9329109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40553960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}