Journal of Clinical Psychopharmacology最新文献

{"title":"Clinical and Demographic Predictors of Early Clozapine Discontinuation Across Mood and Psychotic Disorders.","authors":"Mete Ercis, Kristin C Cole, Ross A Dierkhising, Aysegul Ozerdem, Matej Markota, Balwinder Singh, Susan L McElroy, Mark A Frye, Jonathan G Leung","doi":"10.1097/JCP.0000000000001951","DOIUrl":"10.1097/JCP.0000000000001951","url":null,"abstract":"<p><strong>Background: </strong>Clozapine is effective for treatment-resistant schizophrenia and bipolar disorder but is often discontinued due to adverse effects. This study compared early clozapine discontinuation rates and reasons in patients with mood and psychotic disorders.</p><p><strong>Methods: </strong>Data from all individuals with mood or psychotic disorders who initiated clozapine for the first time at the inpatient psychiatric unit of Mayo Clinic, Rochester, Minnesota, between 2014 and 2022 were retrospectively analyzed. Early clozapine discontinuation, defined as discontinuation within 90 days of initiation, was the primary outcome. Cox proportional hazards regression was used to assess factors associated with discontinuation.</p><p><strong>Results: </strong>Of 83 patients (mood group n = 37, psychosis group n = 46), those in the mood group were older ( P = 0.022) and more likely to be nonsmokers ( P = 0.034). The overall 90-day clozapine discontinuation rate was 45.7%. Early discontinuation was significantly higher in the mood group than in the psychosis group (hazard ratio = 2.41, 95% confidence interval = 1.26-4.64, P = 0.008). Other factors associated with early discontinuation were female sex ( P = 0.033), older age ( P = 0.026), and nonsmoking ( P = 0.001). In multivariable analysis, smoking status was the only factor significantly inversely associated with early clozapine discontinuation (hazard ratio = 0.47, 95% confidence interval = 0.22-0.99, P = 0.048), while diagnostic group, sex, and age did not show significant associations (all P > 0.05). Discontinuations were primarily due to adverse drug reactions in both groups.</p><p><strong>Conclusions: </strong>Nearly half of the patients discontinued clozapine early, with higher rates in the mood group. Studies should further explore potential pharmacodynamic and pharmacokinetic factors associated with discontinuation, including the influence of smoking. Careful monitoring and personalized management of side effects are crucial for optimizing clozapine therapy and improving treatment outcomes.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"85-91"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Insights on Clozapine Dosing: The Role of Gender, Smoking, and the Clozapine/Norclozapine Ratio.","authors":"Sandeep Grover, Rachana Mehta, Sanjit Sah, Mahendra Pratap Singh, Amol N Patil","doi":"10.1097/JCP.0000000000001954","DOIUrl":"10.1097/JCP.0000000000001954","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"171-172"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Hypothermia Associated With the Use of Multiple Antipsychotics in a Patient With Late-Onset Schizophrenia.","authors":"Amanda Eloma-Ata, Fatma Wafy, Amir Parikh, Alan Tusher","doi":"10.1097/JCP.0000000000001961","DOIUrl":"10.1097/JCP.0000000000001961","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"150-152"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oculogyric Crisis Associated With Clozapine: Case Report and Review of Literature.","authors":"Rashmi Shukla, Aleena Thomas","doi":"10.1097/JCP.0000000000001960","DOIUrl":"10.1097/JCP.0000000000001960","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"156-157"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Concomitant Use of Antidepressants and Direct Oral Anticoagulants Increase the Risk of Bleeding?: A Systematic Review and Meta-Analysis.","authors":"Jinyan Weng, Ruying Lan","doi":"10.1097/JCP.0000000000001958","DOIUrl":"10.1097/JCP.0000000000001958","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the risk of bleeding associated with the simultaneous administration of antidepressants (ADs) and direct oral anticoagulants (DOACs).</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus databases were searched for papers that focused on the concomitant administration of ADs and DOACs and presented data on the bleeding outcomes. The comparator group of interest was subjects who received only DOACs. Besides the overall pooled analysis, irrespective of the primary disease condition, we were also interested in studies involving patients with atrial fibrillation (AF). We therefore included studies with relevant comparisons (AD with DOACs, compared to DOACs alone), regardless of the reported underlying condition. Thereafter, we conducted a sensitivity analysis to refine estimates specific to AF. Clinical trials and observational studies were eligible. Pooled effect sizes were reported as relative risk (RR) for studies with cohort design and as odds ratio (OR) for case-control studies.</p><p><strong>Results: </strong>Ten studies were included. Overall pooled analysis showed that treatment with both DOAC and selective serotonin reuptake inhibitor and serotonin and norepinephrine reuptake inhibitor (SSRI/SNRI) was associated with significantly higher risk of major bleeding (cohort: RR 1.25, 95% CI: 1.07-1.47; case-control: OR 1.40, 95% CI: 1.15-1.69). The risk of intracranial bleeding was found to be increased when cohort studies were pooled (RR 1.44, 95% CI: 1.24-1.66), but not with pooling of case-control studies (OR 1.58, 95% CI: 0.43-5.75). The risk of gastrointestinal bleeding and transient ischemic attack (TIA)/ischemic stroke was comparable between the 2 groups (DOAC + SSRI/SNRI vs DOAC only group).</p><p><strong>Conclusions: </strong>Our results indicate that combined SSRIs/SNRIs and DOAC treatment may be associated with increased incidence of major and intracranial bleeding, further emphasizing the importance of caution when considering their concomitant use.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"140-147"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Management of Designer Benzodiazepine Intoxication: A Systematic Review.","authors":"Gregory Noe, Nicholas McDuffee, Katelyn Li, Sahil Munjal","doi":"10.1097/JCP.0000000000001963","DOIUrl":"10.1097/JCP.0000000000001963","url":null,"abstract":"<p><strong>Background: </strong>A subset of novel psychoactive substances (NPS), designer benzodiazepines, are rising in popularity. These compounds are more potent derivatives of prescription benzodiazepines and can lead to profound sedation. Therefore, clinicians are challenged with caring for patients who present with designer benzodiazepine intoxication or withdrawal. We conducted a systematic review of the literature for designer benzodiazepine overdoses with a focus on patient presentation and clinical management.</p><p><strong>Methods: </strong>We conducted a systematic literature search in multiple databases using Medical Subject Headings (MeSH) terms \"designer benzodiazepine(s)\" and \"case report\" along with additional permutations of search terms. We used the PICOS search algorithm to enhance reporting of systematic reviews' findings.</p><p><strong>Results: </strong>A total of 27 articles were selected for inclusion in our systematic review, comprising 35 patient cases. The average patient age was 27.14 years (SD = 9.86), and the male-to-female ratio was 3.38:1. More than half (54.29%) of cases involved designer benzodiazepines alone, whereas 45.71% of cases involved co-ingestions. The most frequent presenting sign was altered mental status. The most frequent abnormal vital sign was tachycardia.</p><p><strong>Discussion: </strong>Management of patients presenting with acute designer benzodiazepine intoxication was highly variable, depending on the severity. We include practical clinical management guidance based on 3 designer benzodiazepine toxidromes including sedation-predominant, withdrawal-predominant, or mixed-sedation with rebound agitation.</p><p><strong>Conclusion: </strong>Designer benzodiazepines are highly potent compounds that present a significant risk to patients and pose a clinical management challenge to clinicians. More research is needed to fully understand the effects of designer benzodiazepines in humans.</p>","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"116-126"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blonanserin-Associated Leukopenia: Two Case Reports.","authors":"Ruyi Zhang, Jia Liu, Shanshan Wang, Dingding Feng, Zhongxuan Ma, Fuquan Zhang","doi":"10.1097/JCP.0000000000001949","DOIUrl":"10.1097/JCP.0000000000001949","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"165-167"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognition of Clozapine-Associated Eosinopenia in Patients With Treatment-Resistant Schizophrenia: A Report of 3 Cases and Literature Review.","authors":"Samuel C Buesking, Carrie R Kriz, Stephen P Jarvis, Leigh Anne Nelson","doi":"10.1097/JCP.0000000000001947","DOIUrl":"10.1097/JCP.0000000000001947","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"148-150"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Neuroleptic Malignant Syndrome: A Case Report and Review of Literature.","authors":"Greg Noe, Kaushal Shah, Samantha Ongchuan-Martin, Sahil Munjal","doi":"10.1097/JCP.0000000000001957","DOIUrl":"10.1097/JCP.0000000000001957","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"154-156"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duloxetine-Associated Erosive Gastritis and Gastroesophageal Reflux: A Case Report.","authors":"Nilgun Oktar Erdogan","doi":"10.1097/JCP.0000000000001952","DOIUrl":"10.1097/JCP.0000000000001952","url":null,"abstract":"","PeriodicalId":15455,"journal":{"name":"Journal of Clinical Psychopharmacology","volume":" ","pages":"167-169"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}