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Journal of Clinical Psychopharmacology最新文献

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Mood Swings and Irritability in a Patient With Cystic Fibrosis on Elexacaftor-Tezacaftor-Ivacaftor Therapy: A Case Report. 一名接受 Elexacaftor-Tezacaftor-Ivacaftor 治疗的囊性纤维化患者的情绪波动和易激惹:病例报告。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-22 DOI: 10.1097/JCP.0000000000001906
Yu-Tung Lan, Yu-Ting Wung
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引用次数: 0
Transitioning From a Standard Low-Dose to a Rapid Low-Dose Buprenorphine Initiation in a Hospital Setting-A Case Report. 在医院环境中从标准小剂量丁丙诺啡过渡到快速小剂量丁丙诺啡--病例报告。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-09 DOI: 10.1097/JCP.0000000000001896
Joseph B Williams, Kory R Dawson, Peter D Le, Huma Tahir
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引用次数: 0
Journal of Clinical Psychopharmacology Updates. 临床精神药理学杂志》更新。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 DOI: 10.1097/JCP.0000000000001913
Anthony J Rothschild
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引用次数: 0
Plasma Clozapine and N -Desmethylclozapine (Norclozapine) Concentrations and the Clozapine/Norclozapine Ratio : Effect of Dose, Sex, and Cigarette Smoking. 血浆氯氮平和 N-去甲氯氮平(诺氯氮平)浓度以及氯氮平/诺氯氮平比率:剂量、性别和吸烟的影响。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-22 DOI: 10.1097/JCP.0000000000001909
Robert James Flanagan, Stephen John Obee, Alice Hyun Min Kim, Susanna Every-Palmer

Background: Smoking enhances plasma clozapine clearance, but the magnitude of the effect across the dose and age ranges is unclear.

Methods: We audited clozapine dose and predose plasma clozapine and N -desmethylclozapine (norclozapine) concentrations by sex and smoking habit in samples submitted for clozapine TDM, 1996-2017.

Results: There were 105,316/60,792 and 34,288/31,309 samples from male/female smokers/nonsmokers, respectively. There were distinct dose-median plasma concentration trajectories for male/female smokers/nonsmokers across the range <50 to >850 mg d -1 . For both sexes, the percentage difference in median plasma clozapine in nonsmokers versus smokers averaged 50% but was greatest for men (76%) and women (59%) in the 151 to 250 mg d -1 dose band. In men, the percentage difference declined steadily to 34% at doses of ≥850 mg d -1 . In women, the difference after falling initially remained relatively constant at 40% to 54%. The pattern in median plasma clozapine/norclozapine ratio by plasma clozapine concentration and dose groups was independent of sex and smoking habit, but increased with plasma clozapine concentration (higher ratio at higher concentrations) and also changed with dose. Median plasma clozapine concentration and median clozapine dose by sex and smoking habit were similar up to age 60 years. Proportional weight gain was similar over time in smokers and nonsmokers of either sex.

Implications: These data explain the variations in the effect size of starting or stopping smoking on plasma clozapine concentration at constant dose reported in different studies. Changes in smoking habit in patients prescribed clozapine require prompt dose adjustment.

背景:吸烟可提高血浆中氯氮平的清除率,但在不同剂量和年龄范围内的影响程度尚不清楚:我们审核了1996-2017年提交的氯氮平TDM样本中按性别和吸烟习惯分列的氯氮平剂量和用药前血浆氯氮平和N-去甲氯氮平(诺氯氮平)浓度:男性/女性吸烟者/非吸烟者样本分别为105,316/60,792和34,288/31,309份。在 850 毫克/天-1 的范围内,男性/女性吸烟者/非吸烟者的血浆中位剂量浓度轨迹截然不同。对于男性和女性而言,非吸烟者与吸烟者的氯氮平中位血浆浓度百分比差异平均为 50%,但在 151 至 250 毫克/天-1 剂量范围内,男性(76%)和女性(59%)的差异最大。男性的百分比差异在剂量≥850 毫克/天时稳步下降至 34%。在女性中,最初下降后的差异相对稳定在 40% 至 54%。不同血浆氯氮平浓度和剂量组的血浆氯氮平/去甲氯氮平比值中位数的变化规律与性别和吸烟习惯无关,但随着血浆氯氮平浓度的增加而增加(浓度越高比值越高),并且随着剂量的增加而变化。按性别和吸烟习惯分列的血浆氯氮平浓度中位数和氯氮平剂量中位数在 60 岁之前是相似的。随着时间的推移,吸烟者和非吸烟者的体重增加比例相似:这些数据解释了不同研究中报道的开始或停止吸烟对血浆中氯氮平浓度在恒定剂量下的影响大小的差异。处方氯氮平的患者如果改变吸烟习惯,需要及时调整剂量。
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引用次数: 0
Antipsychotic Treatment in People at Clinical High Risk for Psychosis: A Narrative Review of Suggestions for Clinical Practice. 精神病临床高危人群的抗精神病治疗:对临床实践建议的叙述性回顾。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-05 DOI: 10.1097/JCP.0000000000001891
Alessandro Di Lisi, Simona Pupo, Marco Menchetti, Lorenzo Pelizza

Purpose: The "early intervention" paradigm in psychiatry holds significant promise for preventing psychosis. Recent evidence showed that individuals at clinical high risk for psychosis (CHR-P) with antipsychotic (AP) prescription at baseline have higher psychosis transition rates compared with those without AP, although the underlying cause remains unclear. In this article, we reviewed international guidelines on early intervention in CHR-P people, paying specific attention to clinical recommendations on AP treatment. Then, we comment on these suggestions in the light of recent empirical evidence examining AP prescription in CHR-P populations within "real-world" clinical settings.

Methods: This search was conducted on PubMed/MEDLINE, PsycINFO, EMBASE, and Google, looking for both "Guidelines AND CHR-P OR UHR OR Early Psychosis."

Results: International guidelines generally recommend not using AP as first-line treatment, but only when psychosocial interventions have failed. CHR-P people with AP drug showed high prevalence rates and had more severe clinical picture at entry. Is this a "warning signal" for potentially higher psychosis transition risk? Is it a direct AP iatrogenic effect? Is it possible to detect specific CHR-P subgroup that may benefit from AP? These are the questions that this article seeks to explore.

Conclusions: The current framework for identifying CHR-P subjects has defined psychometric criteria mainly based on positive symptoms. In our opinion, this is reductive, especially for evaluating therapeutic outcomes and prognosis. A more comprehensive assessment considering quality of life, psychiatric comorbidity, persistent negative symptoms, subjective experience of CHR-P psychopathology, and social/personal recovery is thus needed.

目的:精神病学中的 "早期干预 "模式在预防精神病方面大有可为。最近的证据显示,基线处方抗精神病药物(AP)的临床高危精神病(CHR-P)患者与未处方AP的患者相比,精神病转归率更高,但其根本原因仍不清楚。在这篇文章中,我们回顾了有关对临床高危人群进行早期干预的国际指南,特别关注了有关抗精神病药物治疗的临床建议。然后,我们根据最近在 "真实世界 "的临床环境中对慢性阻塞性肺病患者进行 AP 处方治疗的经验证据,对这些建议进行了评论:方法:在 PubMed/MEDLINE、PsycINFO、EMBASE 和 Google 上进行搜索,同时搜索 "指南 AND CHR-P OR UHR OR Early Psychosis":国际指南普遍建议不要将 AP 作为一线治疗,只有在社会心理干预无效时才使用。患有 AP 药物的 CHR-P 患者发病率较高,入院时的临床表现更为严重。这是否是潜在的较高精神病转变风险的 "预警信号"?这是 AP 的直接先天效应吗?是否有可能发现可能受益于 AP 的特定 CHR-P 亚群?这些都是本文试图探讨的问题:目前用于识别CHR-P受试者的框架主要根据阳性症状来定义心理测量标准。我们认为,这是一种简化的方法,尤其是在评估治疗效果和预后时。因此,需要进行更全面的评估,考虑生活质量、精神病合并症、持续性阴性症状、CHR-P 心理病理学的主观体验以及社会/个人恢复情况。
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引用次数: 0
Painful Ejaculation Associated With Atomoxetine and Bupropion: A Case Report. 与阿托莫西汀和安非他酮相关的射精疼痛:病例报告。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-07-16 DOI: 10.1097/JCP.0000000000001894
Priyadarshini Bera, Deeksha Chakrabarty, Sivapriya Vaidyanathan
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引用次数: 0
Question: How Should I Switch From One Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) to Another SSRI or SNRI in a Patient With Major Depressive Disorder? 问:重度抑郁障碍患者应该如何从一种选择性羟色胺再摄取抑制剂(SSRI)或羟色胺和去甲肾上腺素再摄取抑制剂(SNRI)切换到另一种 SSRI 或 SNRI?
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-22 DOI: 10.1097/JCP.0000000000001907
Anthony J Rothschild
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引用次数: 0
Mania Associated With Cariprazine: A Case Report and a Review of Literature Regarding Bipolar Depression Treatment With Cariprazine. 与卡哌嗪有关的躁狂症:一份病例报告以及有关用卡普拉嗪治疗躁郁症的文献综述。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-07-16 DOI: 10.1097/JCP.0000000000001892
Luís Pedro Paulino Ferreira, Carolina Martins Batista, João Carlos Machado Nogueira, Maria Amélia Silva Aleixo
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引用次数: 0
Late Recognition of Cholinergic Delirium in Patient on Donepezil Combination Treatment. 多奈哌齐联合疗法患者胆碱能谵妄的后期识别。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-08-16 DOI: 10.1097/JCP.0000000000001901
Naomi Gwynn, Jean-Pierre Lindenmayer, Thomas Boes, Christian Pitalo
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引用次数: 0
Comparison of Weight-Based Valproic Acid Dosing in Treatment of Mental Illness Among Obese and Nonobese Patients. 基于体重的丙戊酸剂量在治疗肥胖和非肥胖精神疾病患者中的比较。
IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-01 Epub Date: 2024-07-16 DOI: 10.1097/JCP.0000000000001883
Cindy Trac, Angeleki Zecopoulos, Clint Ross, Erin Weeda, Dan McGraw

Purpose/background: A weight-based dosing approach of 20-30 mg/kg per day of valproic acid (VPA) has been shown to achieve rapid attainment of mood symptom control. Due to interindividual pharmacokinetic variability, therapeutic drug monitoring may be a useful tool to avoid VPA toxicity. Limited research exists on the impact of patient body weight on VPA pharmacokinetic profiles. This analysis aims to explore the correlation between steady-state serum levels of VPA and weight-based dosing strategies, including total body weight (TBW), ideal body weight (IBW), and adjusted body weight (AdjBW), between obese and nonobese patients.

Methods/procedures: This single-center, retrospective, observational cohort analysis evaluated weight-based dosing of VPA in obese and nonobese patients admitted to inpatient psychiatry at a large academic medical center between July 1, 2017, and July 1, 2022.

Findings/results: This analysis included 93 obese and 93 nonobese patients. No significant difference in median VPA serum concentrations was observed between groups ( P = 0.82). However, the obese group received a lower median weight-based dose (15.6 mg/kg) compared with the nonobese group (19.5 mg/kg, P < 0.001). A stronger correlation was found between VPA dose and therapeutic serum levels in the obese group compared with the nonobese group regardless of weight-based dosing strategy. Dosing with AdjBW in obese patients most closely approximated dosing with TBW in nonobese patients.

Implications/conclusions: In obese patients, our analysis suggests dosing VPA using AdjBW may be considered as the preferred dosing strategy over IBW or TBW to minimize toxicity risk. Further research is needed with larger sample sizes and diverse patient populations to confirm these findings.

目的/背景:丙戊酸(VPA)每天 20-30 毫克/千克的体重给药方法已被证明能够快速控制情绪症状。由于个体间药代动力学的差异性,治疗药物监测可能是避免 VPA 药物毒性的有效工具。有关患者体重对 VPA 药代动力学特征影响的研究有限。本分析旨在探讨肥胖和非肥胖患者的 VPA 稳态血清水平与基于体重的给药策略(包括总重量(TBW)、理想体重(IBW)和调整体重(AdjBW))之间的相关性:这项单中心、回顾性、观察性队列分析评估了2017年7月1日至2022年7月1日期间一家大型学术医疗中心精神科住院患者中肥胖和非肥胖患者基于体重的VPA剂量:该分析包括93名肥胖和93名非肥胖患者。两组患者的 VPA 血清浓度中位数无明显差异(P = 0.82)。然而,与非肥胖组(19.5 毫克/千克,P < 0.001)相比,肥胖组接受的基于体重的中位剂量(15.6 毫克/千克)较低。与非肥胖组相比,无论采用哪种基于体重的给药策略,肥胖组的 VPA 剂量与治疗血清水平之间都存在更强的相关性。肥胖患者的 AdjBW 剂量与非肥胖患者的 TBW 剂量最为接近:对于肥胖患者,我们的分析表明,与 IBW 或 TBW 相比,使用 AdjBW 给 VPA 给药可作为首选给药策略,以最大限度地降低毒性风险。要证实这些研究结果,还需要对更大样本量和不同患者群体进行进一步研究。
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Journal of Clinical Psychopharmacology
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