Revista de Psiquiatría y Salud Mental (English Edition)最新文献

英文中文

Valproate, obesity and other causes of clozapine poor metabolism in the context of rapid titration may explain clozapine-induced myocarditis: A re-analysis of a Turkish case series 丙戊酸盐、肥胖和其他氯氮平代谢不良的原因在快速滴定的背景下可以解释氯氮平诱导的心肌炎:对土耳其病例系列的重新分析

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2021.10.001

Aygün Ertuğrul , A. Elif Anıl Yağcıoğlu , Esen Ağaoğlu , Ahmet Alp Karakaşlı , Sertaç Ak , M. Kâzım Yazıcı , Jose de Leon

Introduction

Clozapine-induced myocarditis or any clozapine-induced inflammation may be a hypersensitivity reaction due to titration that was too rapid for the patient's clozapine metabolism. Clozapine metabolism is influenced by ancestry, sex, smoking and the presence of confounders including obesity, infections, and inhibitors (e.g., valproate) causing the patient to behave as a clozapine poor metabolizer (PM). A published study in a Turkish hospital identified 1 case of clozapine-induced pancreatitis and hepatitis and 9 cases of clozapine-induced myocarditis. To explore the hypothesis that the 10 patients were clozapine PMs, their serum clozapine concentrations were investigated using concentration-to-dose (C/D) ratios and their titrations carefully reviewed.

Methods

Dividing the trough serum concentration by the dose produces the clozapine C/D ratio. The dose required to reach 350 ng/ml was considered the minimum therapeutic dosage and was used to classify patients according to clozapine PM status. Titration speed was assessed.

Results

All 10 patients were possibly clozapine PMs (3 of them had as minimum therapeutic doses: 72, 82 or 83 mg/day). Nine of the 10 patients may have behaved as clozapine PMs due to obesity and/or valproate co-prescription during titration. One also had an undiagnosed infection. Of the 10 patients, 9 had at least 1 of 3 factors: too-rapid titration in the first or second weeks, or a final dosage that was too high.

Conclusions

Future studies using clozapine levels and considering the role of clozapine PM status should explore whether or not all cases of clozapine-induced inflammation could be explained by lack of individualized titration.

氯氮平引起的心肌炎或任何氯氮平引起的炎症都可能是一种超敏反应，因为滴定速度太快，患者的氯氮平代谢跟不上。氯氮平代谢受血统、性别、吸烟和混杂因素(包括肥胖、感染和抑制剂(如丙戊酸))的影响，导致患者表现为氯氮平代谢不良者(PM)。土耳其一家医院发表的一项研究发现了1例氯氮平诱发的胰腺炎和肝炎，9例氯氮平诱发的心肌炎。为了探讨这10例患者是否为氯氮平pm的假设，我们使用浓度剂量比(C/D)调查了他们的血清氯氮平浓度，并仔细审查了他们的滴定法。方法用谷血药浓度除以剂量得到氯氮平C/D比。需要达到350 ng/ml的剂量被认为是最低治疗剂量，并根据氯氮平PM状态对患者进行分类。测定滴定速度。结果10例患者均可能为氯氮平经前综合征，其中3例患者最小治疗剂量分别为72、82、83 mg/d。10例患者中有9例可能表现为氯氮平经前综合症，原因是在滴定期间肥胖和/或丙戊酸共处方。其中一人还患有未确诊的感染。在这10例患者中，9例至少有3个因素中的1个:第一或第二周滴药过快，或最终剂量过高。结论未来使用氯氮平水平并考虑氯氮平PM状态的研究应该探讨是否所有氯氮平诱导的炎症病例都可以通过缺乏个体化滴定来解释。

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引用次数: 6

Diagnostic stability in substance-induced psychosis 药物性精神病的诊断稳定性

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2019.10.006

Lucía Inchausti , Iñigo Gorostiza , Miguel Angel Gonzalez Torres , Rodrigo Oraa

Introduction

Substance-induced psychosis (SIP) is the name given to a psychosis that starts in the context of substance abuse but persists for days and weeks with no substance use. There is as yet little knowledge about the longitudinal course of this psychosis, which suggests that significant numbers go on to be diagnosed with a severe mental disorder (SMD). The objective of this study was to analyse the progression of SIP to SMD in our environment and the possible factors that may be involved in that conversion.

Material and Methods

We used a retrospective cohort follow-up design. We reviewed all diagnoses of patients discharged from the psychiatric hospitalisation unit of the University Hospital of Basurto from January 2002 to December 2015 inclusively. In addition to sociodemographic and clinical data, information was collected on the consumption of cannabinoids, opioids, amphetamines, cocaine and alcohol. The data were analysed using descriptive analysis, Kaplan-Meier survival curves and Cox regression.

Results

Of the 116 patients, 78.4% were male, had an average age of 33.0 (SD = 8.9) years and 44.0% were single; 31.0% had a psychiatric family history; the most commonly used substance was cannabis (60.3%), followed by cocaine (40.5%). The cumulative risk of diagnostic conversion to an SMD in 16 years was 41.6% (95%CI: 32.2–52.2) over a mean 36.43 months.

Conclusions

In interventions in episodes of SIP we must bear in mind that a significant proportion will progress to an SMD in the first three years.

物质诱发性精神病(SIP)是一种精神病的名称，它开始于药物滥用的背景下，但在没有药物使用的情况下持续数天或数周。目前对这种精神疾病的纵向病程知之甚少，这表明有相当多的人继续被诊断为严重精神障碍(SMD)。本研究的目的是分析在我们的环境中SIP到SMD的进展，以及可能参与这种转换的可能因素。材料与方法采用回顾性队列随访设计。我们对2002年1月至2015年12月Basurto大学医院精神科出院患者的所有诊断进行了综合分析。除了社会人口和临床数据外，还收集了大麻素、类阿片、安非他明、可卡因和酒精消费的信息。采用描述性分析、Kaplan-Meier生存曲线和Cox回归分析资料。结果116例患者中，男性占78.4%，平均年龄33.0 (SD = 8.9)岁，单身占44.0%;31.0%有精神科家族史;最常使用的物质是大麻(60.3%)，其次是可卡因(40.5%)。16年内诊断转化为SMD的累积风险为41.6% (95%CI: 32.2-52.2)，平均36.43个月。结论:在SIP发作的干预措施中，我们必须记住，很大一部分将在前三年进展为SMD。

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引用次数: 0

Different measures for auditory hallucinations in populations with psychosis. The Validation of the Spanish versions of the Auditory Vocal Hallucination Rating Scale (AVHRS) and the Positive and Useful Voices Inquiry (PUVI) 精神病人群中不同的幻听测量方法。西班牙语版听觉幻听评定量表(AVHRS)和积极有用声音问卷(PUVI)的验证

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2020.03.002

Esther Lorente-Rovira , Eva Grasa , Susana Ochoa , Iluminada Corripio , Trinidad Peláez , Raquel López-Carrilero , Ángela Gutiérrez-Gea , María Morano-Guillén , José M. Villagrán , Agna A. Bartels-Velthuis , Jack A. Jenner , Julio Sanjuán

Introduction

An updated summary of the most used instruments assessing auditory hallucinations in population with psychosis, allows us to underline the scarceness and need of Spanish versions of important instruments. The aim of the study is to examine the psychometric characteristics of two different and complementary instruments for assessing auditory hallucinations, the Spanish version of the Auditory Vocal Hallucination Scale (AVHRS) and the Spanish version of the Positive and Useful Voices Inquiry (PUVI).

Materials and methods

A sample of 68 patients from four different centres, with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder presenting with auditory hallucinations were included. Apart from the AVHRS and the PUVI, the Psychotic Symptom Rating Scales-Auditory Hallucinations subscale (PSYRATS-AH) and the Positive and Negative Syndrome Scale (PANSS) were also administered to all patients, plus an acceptability questionnaire.

Results

The Spanish version of the AVHRS showed a good internal consistency, a moderate to high inter-rater reliability, a medium to moderate test–retest reliability, and a good convergent and discriminant validity. The Spanish version of the PUVI showed a good internal consistency and a heterogeneous, but in general moderate, test–retest reliability.

Conclusions

The Spanish versions of the AVHRS and the PUVI have good psychometric properties and are well accepted among patients.

一份最新的评估精神病患者幻听的最常用仪器的总结，使我们能够强调西班牙语版本重要仪器的稀缺和需求。本研究的目的是检验两种不同的、互补的评估幻听的工具的心理测量特征，西班牙语版的听觉幻觉量表(AVHRS)和西班牙语版的积极和有用的声音调查(PUVI)。材料和方法来自四个不同中心的68例患者样本，均被诊断为精神分裂症或分裂情感性障碍，并伴有幻听。除AVHRS和PUVI外，还对所有患者进行精神病症状评定量表-幻听子量表(PSYRATS-AH)和阳性和阴性综合征量表(PANSS)，并进行可接受性问卷调查。结果西班牙语版AVHRS具有较好的内部一致性、中至高的量表间信度、中至中等的重测信度、较好的收敛效度和判别效度。西班牙语版本的PUVI表现出良好的内部一致性和异质性，但总体上中等，重测信度。结论西班牙语版AVHRS和PUVI具有良好的心理测量性能，为患者所接受。

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引用次数: 0

A clozapine's uncharted voyage: Five years and a pandemic after the end of mandatory haematological notifications to the Spanish medicines agency 氯氮平的未知航程:西班牙药品管理局强制血液学通报结束后的五年和大流行

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2022.04.001

Pilar Andres-Olivera , Concha Turrion , Emilio Fernandez-Egea , Jesus Perez

引用次数: 0

Clozapine for the treatment of pediatric encephalopathy associated with nonketotic hyperglycinemia 氯氮平治疗小儿脑病伴非酮症性高血糖症

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2022.10.001

Sara Jiménez-Fernández , Manuel Gurpegui , Jose de Leon , Luis Gutiérrez-Rojas

引用次数: 0

Clozapine-associated myocarditis in the World Health Organization's pharmacovigilance database: Focus on reports from various countries 世界卫生组织药物警戒数据库中的氯氮平相关性心肌炎:关注来自不同国家的报告

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2021.07.005

Carlos De las Cuevas , Emilio J. Sanz , Can-Jun Ruan , Jose de Leon

Introduction

The incidence of clozapine-associated myocarditis varies by country. These variations were explored in VigiBase, the World Health Organization's global database which has >25 million spontaneously reported adverse drug reaction (ADR) reports from 145 national drug agencies.

Methods

On January 15, 2021, a search of VigiBase since inception focused on myocarditis in clozapine patients. The 3572 individual reports were studied using the standard VigiBase logarithmic measure of disproportionality called information component (IC). The IC measures the disproportionality between the expected and the reported rates. After duplicates were eliminated there were 3274 different patients with myocarditis studied in logistic regression models.

Results

The first case was published in 1980 but since 1993 the VigiBase clozapine-myocarditis IC has been significant; moreover, currently it is very strong (IC = 6.0, IC₀₀₅–IC₉₉₅ = 5.9–6.1) and statistically significantly different from other antipsychotics. Of the 3274 different patients with myocarditis, 43.4% were non-serious cases, 51.8% were serious but non-fatal, and 4.8% were fatal. More than half (1621/3274) of the reports came from Australia, of which 69.2% were non-serious, 27.7% serious but non-fatal, and 3.1% fatal. Asian countries contributed only 41 cases.

Conclusions

In pharmacovigilance studies, confounding factors may explain statistical associations, but the strength and robustness of these results are compatible with the hypothesis that myocarditis is definitively associated with early clozapine treatment (84% [1309/1560] and 5% [82/1560] in the first and second months). Myocarditis reports from Australia are over-represented to a major degree. Asian countries may be underreporting myocarditis to their drug agencies.

氯氮平相关性心肌炎的发病率因国家而异。VigiBase是世界卫生组织的全球数据库，该数据库拥有来自145个国家药品机构的2500万份自发报告的药物不良反应(ADR)报告。方法:2021年1月15日，VigiBase自成立以来的搜索重点是氯氮平患者的心肌炎。使用标准的VigiBase对歧化率的对数测量(称为信息成分(IC))研究了3572个单独的报告。IC衡量的是预期比率和报告比率之间的不相称性。剔除重复后，在logistic回归模型中对3274例不同的心肌炎患者进行了研究。结果第一例病例发表于1980年，但自1993年以来，VigiBase氯氮平心肌炎IC显著;而且，目前它的药效非常强(IC = 6.0, IC005-IC995 = 5.9-6.1)，与其他抗精神病药物有统计学差异。3274例不同类型心肌炎患者中，不严重者占43.4%，严重但不致命者占51.8%，致命者占4.8%。超过一半(1621/3274)的报告来自澳大利亚，其中69.2%不严重，27.7%严重但不致命，3.1%致命。亚洲国家只有41例。结论在药物警戒研究中，混杂因素可以解释统计学相关性，但这些结果的强度和稳健性与心肌炎与早期氯氮平治疗明确相关的假设是一致的(84%[1309/1560]和5%[82/1560]在第一个月和第二个月)。来自澳大利亚的心肌炎报告在很大程度上被夸大了。亚洲国家可能少报心肌炎给他们的药品机构。

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引用次数: 1

Clozapine-induced myocarditis in Russia: Animal studies but no clinical studies 氯氮平引起的心肌炎在俄罗斯:动物研究但没有临床研究

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2021.09.001

Oleg O. Kirilochev , Carlos De las Cuevas , Jose de Leon

引用次数: 8

A Covid-19 outbreak in a Spanish long-term psychiatric hospital led to infections in 6 clozapine patients: elevations in their plasma clozapine levels 西班牙一家长期精神病院爆发的Covid-19疫情导致6名氯氮平患者感染:血浆氯氮平水平升高

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2022.06.010

Manuel Arrojo-Romero , Maria Rosario Codesido-Barcala , Jose de Leon

引用次数: 1

Here we go again! Subtyping diagnosis and refining treatments 又来了!分型诊断和细化治疗

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2022.11.001

Javier Vázquez-Bourgon

引用次数: 0

Dried Blood Spot (DBS) as a useful tool to improve clozapine, aripiprazole and paliperidone treatment: From adherence to efficiency 干血斑(DBS)作为改善氯氮平、阿立哌唑和帕利哌酮治疗的有用工具:从依从性到有效性

Revista de Psiquiatría y Salud Mental (English Edition)

Pub Date : 2022-10-01 DOI: 10.1016/j.rpsmen.2022.04.002

Miguel Bernardo , Gisela Mezquida , Paula Ferré , Bibiana Cabrera , Mercè Torra , Ana Maria Lizana , Mercè Brunet

Introduction

Therapeutic Drug Monitoring (TDM) of antipsychotics in schizophrenia is a powerful tool that allows tailoring the treatment in an individualized approach. Our goals are to develop and validate a Dried Blood Spot (DBS) method for monitoring some commonly used antipsychotics (aripiprazole, clozapine, and paliperidone) and to evaluate its usefulness as a compliance biomarker, as well as in drug-dose adjustment to personalize the antipsychotic treatment to improve its efficacy and safety.

Methods

31 first-psychotic episode (FEP) and schizophrenia patients were included; 5 refer to naïve FEP who started antipsychotic treatment; 26, to patients with more than one episode and under antipsychotic treatment: aripiprazole (7 cases), clozapine (17), paliperidone (11). For DBS sample collection, 25 μl of capillary blood were placed in the spot of a FTA™DMPK-C-card. After completely dryness, antipsychotics were extracted and analyzed by a validated UHPLC-MS/MS-method. DBS antipsychotic results were compared with those obtained in venous blood/plasma.

Results

Aripiprazole, paliperidone and clozapine showed from good to excellent correlations between concentrations in venous blood and DBS capillary blood (r², from 0.500 to 0.721). The correlation between conventional plasma and DBS concentrations for paliperidone, aripiprazole, clozapine, and their metabolites were moderate, suggesting that optimal drug target concentrations should be established for DBS.

Conclusions

In this study, for aripiprazole, dehydroaripiprazole, paliperidone, clozapine and desmethylclozapine, DBS has provided good analytical performance for TDM. Thus, DBS sampling can offer a great alternative over conventional sampling for plasma measurement. The assay provides good analytical performances for TDM and clinical research applicability, suggesting that DBS is a promising clinical application in TDM in psychiatry.

精神分裂症患者抗精神病药物的治疗性药物监测(TDM)是一种强有力的工具，它允许以个性化的方法定制治疗。我们的目标是开发和验证一种干血斑(DBS)方法，用于监测一些常用的抗精神病药物(阿立哌唑、氯氮平和帕利哌酮)，并评估其作为依从性生物标志物的有效性，以及在药物剂量调整方面的有效性，以个性化抗精神病药物治疗，提高其有效性和安全性。方法纳入31例首发精神病发作(FEP)和精神分裂症患者;5 .参考naïve FEP者开始抗精神病药物治疗;26例，一次以上发作并接受抗精神病药物治疗的患者:阿立哌唑(7例)，氯氮平(17例)，帕利哌酮(11例)。DBS采集时，取25 μl毛细血管血置于FTA™dmpk -c卡上。完全干燥后，提取抗精神病药物，采用高效液相色谱-质谱联用法进行分析。DBS抗精神病结果与静脉血/血浆比较。结果阿立哌唑、帕利哌酮和氯氮平静脉血浓度与DBS毛细血管血浓度呈从良好到极好的相关性(r2为0.500 ~ 0.721)。帕利哌酮、阿立哌唑、氯氮平及其代谢物的常规血浆浓度与DBS浓度的相关性为中等，提示DBS的最佳药物靶浓度应确定。结论在本研究中，对于阿立哌唑、脱氢阿立哌唑、帕利哌酮、氯氮平和去甲基氯氮平，DBS对TDM具有良好的分析性能。因此，DBS采样可以为等离子体测量提供比传统采样更好的选择。该方法对TDM具有良好的分析性能和临床研究适用性，提示DBS在精神病学TDM的临床应用前景广阔。

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