Therapeutic Advances in Psychopharmacology最新文献

{"title":"Classic psychedelics, health behavior, and physical health.","authors":"Otto Simonsson, Peter S Hendricks, Richard Chambers, Walter Osika, Simon B Goldberg","doi":"10.1177/20451253221135363","DOIUrl":"10.1177/20451253221135363","url":null,"abstract":"<p><strong>Background: </strong>Preliminary evidence suggests that classic psychedelics may be effective in the treatment of some psychiatric disorders, yet little remains known about their effects on health behavior and physical health.</p><p><strong>Objectives: </strong>The purpose of this study was to investigate associations of lifetime classic psychedelic use and psychological insight during one's most insightful classic psychedelic experience with health behavior and physical health.</p><p><strong>Methods: </strong>Using data representative of the US population with regard to sex, age, and ethnicity (<i>N</i> = 2822), this study examined associations of lifetime classic psychedelic use and psychological insight with health behavior and physical health.</p><p><strong>Results: </strong>Lifetime classic psychedelic use was associated with more healthy tobacco-related and diet-related behavior (<i>β</i> = 0.05 and 0.09, respectively). Among lifetime classic psychedelic users (<i>n</i> = 613), greater Psychological Insight Questionnaire (PIQ) total scale, PIQ Avoidance and Maladaptive Patterns (AMP) subscale, and PIQ Goals and Adaptive Patterns (GAP) subscale scores were each associated with higher odds of more healthy exercise-related behavior [adjusted odds ratios (aOR) (95% confidence interval, CI = 1.38 (1.13-1.68), 1.38 (1.13-1.68), and 1.32 (1.10-1.60), respectively] and higher odds of having a healthy body mass index (BMI) [aOR (95% CI) = 1.32 (1.07-1.63), 1.36 (1.10-1.69), and 1.23 (1.01-1.50), respectively], and greater GAP subscale scores were associated with more healthy diet-related behavior (<i>β</i> = 0.10). All PIQ scales were positively associated with some health behavior improvements (overall, diet, exercise) attributed to respondents' most insightful classic psychedelic experience (<i>β</i> = 0.42, 0.18, and 0.17; <i>β</i> = 0.40, 0.19, and 0.17; and <i>β</i> = 0.40, 0.15, and 0.15, respectively), but only PIQ total scale and AMP subscale scores were positively associated with alcohol-related health behavior improvements (<i>β</i> = 0.13 and 0.16, respectively).</p><p><strong>Conclusion: </strong>Although these results cannot demonstrate causality, they suggest that psychological insight during a classic psychedelic experience may lead to positive health behavior change and better physical health in some domains, in particular in those related to weight management.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221135363"},"PeriodicalIF":3.4,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9716448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10830026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of cannabidiol in patients with psychosis.","authors":"Edward Chesney,&nbsp;Doga Lamper,&nbsp;Millie Lloyd,&nbsp;Dominic Oliver,&nbsp;Emily Hird,&nbsp;Philip McGuire","doi":"10.1177/20451253221128445","DOIUrl":"10.1177/20451253221128445","url":null,"abstract":"<p><strong>Background: </strong>Cannabidiol (CBD) is a promising novel candidate treatment for psychosis. It has a more benign side effect profile than antipsychotic medications, and being treated with CBD is not perceived as being stigmatising. These observations suggest that patients with psychosis would find CBD to be a relatively acceptable treatment.</p><p><strong>Objective: </strong>This study tested the above hypothesis by assessing the views of a sample of patients.</p><p><strong>Methods: </strong>Patients with a psychotic disorder were invited to complete a survey exploring their expectations about the efficacy and side effects of CBD.</p><p><strong>Results: </strong>Seventy patients completed the survey. The majority (86%) were willing to try CBD as a treatment. Most patients believed that CBD would improve their psychotic symptoms (69%) and that it would have fewer side effects than their current medication (64%; mainly antipsychotics). A minority of patients (10%) were concerned that CBD might exacerbate their psychotic symptoms. This, however, appeared to reflect confusion between the effects of CBD and those of cannabis.</p><p><strong>Conclusion: </strong>Most patients with psychosis regard CBD as an acceptable treatment. Although CBD has not yet been approved as a treatment for psychosis, many patients are aware of it through the presence of CBD in cannabis and in health supplements. When added to the emerging evidence of its efficacy and the low risk of side effects, the high acceptability of CBD underlines its therapeutic potential.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221128445"},"PeriodicalIF":4.2,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10566590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histone Deacetylase 6 Inhibitor JS28 Prevents Pathological Gene Expression in Cardiac Myocytes.","authors":"Vivien Ngo, Bernd K Fleischmann, Manfred Jung, Lutz Hein, Achim Lother","doi":"10.1161/JAHA.122.025857","DOIUrl":"10.1161/JAHA.122.025857","url":null,"abstract":"<p><p>Background Epigenetic modulators have been proposed as promising new drug targets to treat adverse remodeling in heart failure. Here, we evaluated the potential of 4 epigenetic drugs, including the recently developed histone deacetylase 6 (HDAC6) inhibitor JS28, to prevent endothelin-1 induced pathological gene expression in cardiac myocytes and analyzed the chromatin binding profile of the respective inhibitor targets. Methods and Results Cardiac myocytes were differentiated and puromycin-selected from mouse embryonic stem cells and treated with endothelin-1 to induce pathological gene expression (938 differentially expressed genes, q<0.05). Dysregulation of gene expression was at least in part prevented by epigenetic inhibitors, including the pan-BRD (bromodomain-containing protein) inhibitor bromosporine (290/938 genes), the BET (bromodomain and extraterminal) inhibitor JQ1 (288/938), the broad-spectrum HDAC inhibitor suberoylanilide hydroxamic acid (227/938), and the HDAC6 inhibitor JS28 (210/938). Although the 4 compounds were similarly effective toward pathological gene expression, JS28 demonstrated the least adverse effects on physiological gene expression. Genome-wide chromatin binding profiles revealed that HDAC6 binding sites were preferentially associated with promoters of genes involved in RNA processing. In contrast, BRD4 binding was associated with genes involved in core cardiac myocyte functions, for example, myocyte contractility, and showed enrichment at enhancers and intronic regions. These distinct chromatin binding profiles of HDAC6 and BRD4 might explain the different effects of their inhibitors on pathological versus physiological gene expression. Conclusions In summary, we demonstrated, that the HDAC6 inhibitor JS28 effectively prevented the adverse effects of endothelin-1 on gene expression with minor impact on physiological gene expression in cardiac myocytes. Selective HDAC6 inhibition by JS28 appears to be a promising strategy for future evaluation in vivo and potential translation into clinical application.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"6 1","pages":"e025857"},"PeriodicalIF":0.0,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87521326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will psilocybin lose its magic in the clinical setting?","authors":"Caroline Hayes, M. Wahba, S. Watson","doi":"10.1177/20451253221090822","DOIUrl":"https://doi.org/10.1177/20451253221090822","url":null,"abstract":"Psilocybin as a novel treatment for depression is garnering a lot of attention from both the mainstream media and the academic community. Although phase 3 trials are only just beginning, we feel that it is important for clinicians to consider what psilocybin-assisted psychotherapy might look like in the clinical setting. In this narrative review article we have considered the difficulties that may arise as psilocybin emerges from the research setting, which may hamper its progress towards becoming a licenced medication. Psilocybin has its own unique challenges: the expectation patients come to dosing with having read overwhelmingly positive media; patient suggestibility under the influence of psilocybin and requirement for specialised therapists to name a few. We have also made some recommendations for measures that should be taken in both the phase 3 trials and with clinicians to try and minimise some of the issues raised. In doing so our hope is that psilocybin will continue towards becoming a licenced medication that suitable patients are able to access with relative ease. Practicing psychiatrists need to have an awareness of the potential pitfalls of psilocybin as they will be responsible for prescribing it in the future.","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46162690","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":"Time to rehospitalization in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics or oral antipsychotics","authors":"Ching-Hua Lin, H. Chan, Fu-Chiang Wang, Chun-Chi Hsu","doi":"10.1177/20451253221079165","DOIUrl":"https://doi.org/10.1177/20451253221079165","url":null,"abstract":"Background: Involuntarily hospitalized individuals suffering from schizophrenia often have a poorer prognosis after discharge. Objective: This study aimed to analyze time to rehospitalization within 6 months of discharge in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). In addition, temporal trends in LAI use at discharge were explored. Methods: Involuntarily hospitalized individuals suffering from schizophrenia discharged from the study hospital between 2006 and 2019 (n = 806) were included in the analysis. Survival analysis was used to compare time to rehospitalization within 6 months of discharge between individuals discharged on LAIs and OAPs, and between first-generation antipsychotic (FGA) LAIs and second-generation antipsychotic (SGA) LAIs. The Cochran–Armitage trend test was used to test whether a temporal trend existed for LAIs use at discharge during the study period. Results: The LAIs group (n = 231) had a significantly lower rate of rehospitalization and a significantly longer time to rehospitalization than the OAPs group (n = 575). Rehospitalization rate and time to rehospitalization were not significantly different between individuals discharged on FGA-LAIs and SGA-LAIs. LAIs use at discharge grew significantly from 16.77% in 2006 to 50.00% in 2019 (Z = 6.81, p < 0.0001). Among all LAIs, only use of SGA-LAIs at discharge increased significantly (Z = 5.74, p < 0.0001), but not FGA-LAIs. Conclusions: LAIs were superior to OAPs in preventing rehospitalization. However, SGA-LAIs were comparable with FGA-LAIs in reducing rehospitalization risk. Use of LAIs increased significantly in discharged involuntarily hospitalized individuals during the study period, especially SGA-LAIs.","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42693882","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":"Current perspectives on the epidemiology and burden of tardive dyskinesia: a focused review of the clinical situation in Japan.","authors":"Yasuhiro Mori,&nbsp;Hiroyoshi Takeuchi,&nbsp;Yuichiro Tsutsumi","doi":"10.1177/20451253221139608","DOIUrl":"https://doi.org/10.1177/20451253221139608","url":null,"abstract":"<p><p>Tardive dyskinesia (TD) is a movement disorder that can develop with the use of dopamine receptor-blocking agents and is most commonly caused by antipsychotics. The use of antipsychotics is expanding, which may lead to an increased number of patients experiencing TD. To summarise the current knowledge of the epidemiology and risk factors for TD in Japan, we reviewed articles related to the current state of knowledge around TD identified through a PubMed search, and held a roundtable discussion of experts in Japan on 9 September 2021 to form the basis of the opinion presented within this review. The true prevalence of TD among patients treated with antipsychotics is not well characterised; it is reported to be between 15% and 50% globally and between 6.5% and 7.7% in Japan. Potential barriers to timely treatment of TD include the stigma surrounding mental health issues and the lack of data regarding TD in Asian patients. This review summarises the current knowledge of the epidemiology, challenges to TD diagnosis and risk factors for TD in Japan. Recent strategies for symptom monitoring and early diagnosis, as well as consensus recommendations are included. Achieving a high level of awareness of TD among physicians who treat patients with psychiatric disorders is of great importance and physicians should ensure that patients with psychiatric disorders receiving antipsychotics are proactively monitored for signs of TD.</p><p><strong>Plain language summary: </strong><b>Plain Language Summary (In Japanese)</b>.</p><p><strong>Visual summary: </strong><b>Visual Summary (In Japanese)</b>.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221139608"},"PeriodicalIF":4.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/7e/10.1177_20451253221139608.PMC9806439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10546545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risperidone-induced neuroleptic malignant syndrome: a case report","authors":"L. Deng, Z. Qiu, Mao-yun Wang","doi":"10.1177/20451253221094960","DOIUrl":"https://doi.org/10.1177/20451253221094960","url":null,"abstract":"Neuroleptic malignant syndrome (NMS) is a rare illness that results from reactions to antipsychotics. However, the diagnosis of NMS is challenging due to its atypical clinical presentation and unclear pathogenesis. We report the case of a patient with NMS induced by irregular use of antipsychotics, especially risperidone (RSP). He had typical hyperthermia, muscle rigidity and rhabdomyolysis, which led to renal impairment. We carefully analysed the mechanism by which NMS occurred in this patient. An interesting aspect of the case is the synergistic involvement of risperidone, antidepressants, opioids and stress. Because of these complex predisposing factors, it is difficult to completely rule out the diagnosis of malignant hyperthermia (MH). In addition, the rare phenomenon of elevated lipase and amylase was observed in this patient.","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44740150","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":"Gut microbiome in schizophrenia and antipsychotic-induced metabolic alterations: a scoping review","authors":"Raghunath Singh, N. Stogios, E. Smith, Jiwon Lee, Kateryna Maksyutynsk, Emily Au, D. Wright, G. De Palma, A. Graff-Guerrero, P. Gerretsen, D. Müller, G. Remington, M. Hahn, S. Agarwal","doi":"10.1177/20451253221096525","DOIUrl":"https://doi.org/10.1177/20451253221096525","url":null,"abstract":"Schizophrenia (SCZ) is a severe mental disorder with high morbidity and lifetime disability rates. Patients with SCZ have a higher risk of developing metabolic comorbidities such as obesity and diabetes mellitus, leading to increased mortality. Antipsychotics (APs), which are the mainstay in the treatment of SCZ, increase the risk of these metabolic perturbations. Despite extensive research, the mechanism underlying SCZ pathophysiology and associated metabolic comorbidities remains unclear. In recent years, gut microbiota (GMB) has been regarded as a ‘chamber of secrets’, particularly in the context of severe mental illnesses such as SCZ, depression, and bipolar disorder. In this scoping review, we aimed to investigate the underlying role of GMB in the pathophysiology of SCZ and metabolic alterations associated with APs. Furthermore, we also explored the therapeutic benefits of prebiotic and probiotic formulations in managing SCZ and AP-induced metabolic alterations. A systematic literature search yielded 46 studies from both preclinical and clinical settings that met inclusion criteria for qualitative synthesis. Preliminary evidence from preclinical and clinical studies indicates that GMB composition changes are associated with SCZ pathogenesis and AP-induced metabolic perturbations. Fecal microbiota transplantation from SCZ patients to mice has been shown to induce SCZ-like behavioral phenotypes, further supporting the plausible role of GMB in SCZ pathogenesis. This scoping review recapitulates the preclinical and clinical evidence suggesting the role of GMB in SCZ symptomatology and metabolic adverse effects associated with APs. Moreover, this scoping review also discusses the therapeutic potentials of prebiotic/probiotic formulations in improving SCZ symptoms and attenuating metabolic alterations related to APs.","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43401079","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":"Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey","authors":"Alistair J. Reid Finlayson, Jane Macoubrie, Christy Huff, D. Foster, Peter R. Martin","doi":"10.1177/20451253221082386","DOIUrl":"https://doi.org/10.1177/20451253221082386","url":null,"abstract":"Background: Over 92 million prescriptions for benzodiazepines are dispensed in the United States annually, yet little is known about the experiences of those taking and discontinuing them. Objective: The aim of this study is to assess the experiences of those taking, tapering, or having discontinued benzodiazepines. Methods: An online survey (n = 1207) elicited information about benzodiazepine use, including long-term use, tapering, discontinuation, and withdrawal symptoms. Results: Symptoms associated with benzodiazepine use, tapering, and discontinuation were numerous and ranged from symptoms such as anxiety, insomnia, and nervousness to digestive problems, irregular heart rhythms, uncontrollable anger, photosensitivity, balance problems, and others. When asked how benzodiazepine symptoms affected their lives, 82.9% reported work problems, 86.3% had problems with social interactions and friendships, and 88.8% had problems with fun, recreation, and hobbies. Suicidal thoughts or attempted suicide was reported by 54.4%, and 46.8% said benzodiazepines caused lost employment. Most of the respondents for whom benzodiazepines were prescribed (76.2%) stated they had not been informed that benzodiazepines were indicated for short-term use only and that discontinuation might be difficult. About a third (31.5%) reported food allergies and/or seasonal allergies that occurred only after benzodiazepine use. Conclusion: The trajectory of those who taper or discontinue benzodiazepines is unpredictable, and many patients experience a range of protracted and severe symptoms, even years after benzodiazepines were completely discontinued. Greater awareness is needed for both prescribers and patients about the potential for a difficult withdrawal from benzodiazepines.","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46887038","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":"Reasons for admission to a general medical hospital for patients taking clozapine.","authors":"Siobhan Gee,&nbsp;Vasco Almeida,&nbsp;Adam Hughes,&nbsp;Isabel McMullen,&nbsp;David Taylor","doi":"10.1177/20451253221136753","DOIUrl":"https://doi.org/10.1177/20451253221136753","url":null,"abstract":"<p><strong>Background: </strong>Clozapine is associated with a diverse range of side effects. In addition, patients prescribed clozapine commonly suffer with medical comorbidities.</p><p><strong>Objectives: </strong>This study aimed to characterise patients prescribed clozapine who required medical admission, understand reasons for admission, identify areas for interventions to prevent future admission and describe clozapine management during the inpatient stay.</p><p><strong>Design: </strong>We conducted a retrospective analysis of patients prescribed clozapine who were admitted to a general medical hospital in a 12-month period.</p><p><strong>Method: </strong>Data were collected using electronic drug charts and notes.</p><p><strong>Results: </strong>In total, 114 clozapine patients were hospitalised. Twenty-eight patients (25%) were admitted because of infection, 12 (11%) were elective admissions and 12 (11%) had gastrointestinal problems. Most patients admitted were Black (54%) and half were female. Few changes were made to clozapine dosing on admission or during the inpatient stay. Most patients had been taking clozapine for many years at the point of admission, the majority were able to continue taking it for the duration of their medical treatment and were discharged on the same dose they were taking prior to admission. Clozapine plasma concentrations were not consistently measured with only 18 (16%) patients having one or more plasma concentrations determined during their admission. The median clozapine plasma concentration on admission was 0.48 mg/L (nor-clozapine 0.21 mg/L), with a range of 0.09 to 3.9 mg/L. Three patients were admitted to the intensive care unit during their admission; all were discharged on clozapine. Four patients died; one from lung adenocarcinoma, one bowel obstruction, one cardiac arrest and one chest sepsis. In total, 27 patients (23%) had their clozapine stopped on admission, 6 (22% of this group) unintentionally.</p><p><strong>Conclusions: </strong>Our study found that the most common reason for admission for patients taking clozapine was infection. Plasma concentrations were not measured routinely despite clozapine having a narrow therapeutic index and enhanced potential for toxicity in the medically unwell patient.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221136753"},"PeriodicalIF":4.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/3f/10.1177_20451253221136753.PMC9793060.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10446292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}