Psychotropic medication challenges in patients with Covid-19
DOI:
https://doi.org/10.6016/ZdravVestn.3186Keywords:
coronavirus SARS-CoV-2, mental disorders, psychopathological symptoms, psychotropic drugs, drug-drug interactionsAbstract
he SARS-CoV-2 pandemic has brought a “new reality” into the management of patients with mental disorders. Due to the lack of Covid-19 specific psychopharmacology guidelines as well as shortage of clinical experiences, prescribing psychotropic medications to Covid-19 patients may be associated with some challenges. Interactions between psychotropic drugs and drugs for the treatment of Covid-19, and the adverse effects of psychotropic drugs on the symptoms of infection occasionally require adjustment of psychopharmacotherapy in Covid-19 psychiatric patients. On the other hand, the potential drug-drug interactions and the effect of psychotropic drugs on the course of infection should be considered when treating psychopathological symptoms that may be caused by SARS-CoV-2 infection or drugs used to treat the infection. In the paper, several considerations in prescribing psychopharmacotherapy to patients with Covid-19 are discussed and, based on the literature published in recent months, recommendations for the choice of therapy for acute psychiatric conditions in these patients are summarized.
Downloads
References
1. Zhang K, Zhou X, Liu H, Hashimoto K. Treatment concerns for psychiatric symptoms in patients with COVID-19 with or without psychiatric disorders. Br J Psychiatry. 2020;217(1):351.
DOI: 10.1192/bjp.2020.84
PMID: 32270760
2. Luykx JJ, van Veen SM, Risselada A, Naarding P, Tijdink JK, Vinkers CH. Safe and informed prescribing of psychotropic medication during the COVID-19 pandemic. Br J Psychiatry. 2020;217(3):471-4.
DOI: 10.1192/bjp.2020.92
PMID: 32362299
3. Hamm BS, Rosenthal LJ. Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of Coronavirus Disease-2019: Psychopharmacological Interactions and Neuropsychiatric Sequelae. Psychosomatics. 2020;61(6):597-606.
DOI: 10.1016/j.psym.2020.06.022
PMID: 32800347
4. Anmella G, Arbelo N, Fico G, Murru A, Llach CD, Madero S, et al. COVID-19 inpatients with psychiatric disorders: real-world clinical recommendations from an expert team in consultation-liaison psychiatry. J Affect Disord. 2020;274:1062-7.
DOI: 10.1016/j.jad.2020.05.149
PMID: 32663933
5. Bilbul M, Paparone P, Kim AM, Mutalik S, Ernst CL. Psychopharmacology of COVID-19. Psychosomatics. 2020;61(5):411-27.
DOI: 10.1016/j.psym.2020.05.006
PMID: 32425246
6. Seminog OO, Goldacre MJ. Risk of pneumonia and pneumococcal disease in people with severe mental illness: english record linkage studies. Thorax. 2013;68(2):171-6.
DOI: 10.1136/thoraxjnl-2012-202480
PMID: 23242947
7. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):e21.
DOI: 10.1016/S2215-0366(20)30090-0
PMID: 32199510
8. Sun S, Lin D, Operario D. Need for a population health approach to understand and address psychosocial consequences of COVID-19. Psychol Trauma. 2020;12:S25-7.
DOI: 10.1037/tra0000618
PMID: 32496107
9. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020;87:34-9.
DOI: 10.1016/j.bbi.2020.04.027
PMID: 32298803
10. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.
DOI: 10.1136/bmj.m1091
PMID: 32217556
11. Ludwig S, Zarbock A. Coronaviruses and SARS-CoV-2: A Brief Overview. Anesth Analg. 2020;131(1):93-6.
DOI: 10.1213/ANE.0000000000004845
PMID: 32243297
12. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
DOI: 10.1038/s41586-020-2012-7
PMID: 32015507
13. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
DOI: 10.1016/S0140-6736(20)30183-5
PMID: 31986264
14. Lam MH, Wing YK, Yu MW, Leung CM, Ma RC, Kong AP, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009;169(22):2142-7.
DOI: 10.1001/archinternmed.2009.384
PMID: 20008700
15. Wintermann GB, Brunkhorst FM, Petrowski K, Strauss B, Oehmichen F, Pohl M, et al. Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med. 2015;43(6):1213-22.
DOI: 10.1097/CCM.0000000000000936
PMID: 25760659
16. Lund-Sørensen H, Benros ME, Madsen T, Sørensen HJ, Eaton WW, Postolache TT, et al. A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide. JAMA Psychiatry. 2016;73(9):912-9.
DOI: 10.1001/jamapsychiatry.2016.1594
PMID: 27532502
17. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787-94.
DOI: 10.1001/jama.2010.1553
PMID: 20978258
18. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.
DOI: 10.1001/jamaneurol.2020.1127
PMID: 32275288
19. Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol. 2020;108(1):17-41.
DOI: 10.1002/JLB.3COVR0520-272R
PMID: 32534467
20. Yang Y, Shen C, Li J, Yuan J, Wei J, Huang F, et al. Plasma IP-10 and MCP-3 levels are highly associated with disease severity and predict the progression of COVID-19. J Allergy Clin Immunol. 2020;146(1):119-127.e4.
DOI: 10.1016/j.jaci.2020.04.027
PMID: 32360286
21. Nwafor DC, Brichacek AL, Mohammad AS, Griffith J, Lucke-Wold BP, Benkovic SA, et al. Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment. J Cent Nerv Syst Dis. 2019;11:1179573519840652.
DOI: 10.1177/1179573519840652
PMID: 31007531
22. Sharshar T, Polito A, Checinski A, Stevens RD. Septic-associated encephalopathy—everything starts at a microlevel. Crit Care. 2010;14(5):199.
DOI: 10.1186/cc9254
PMID: 21067627
23. Li Y, Fu L, Gonzales DM, Lavi E. Coronavirus neurovirulence correlates with the ability of the virus to induce proinflammatory cytokine signals from astrocytes and microglia. J Virol. 2004;78(7):3398-406.
DOI: 10.1128/JVI.78.7.3398-3406.2004
PMID: 15016862
24. Salluh JIF, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.
DOI: 10.1136/bmj.h2538
PMID: 26041151
25. Chung HY, Wickel J, Brunkhorst FM, Geis C. Sepsis-associated encephalopathy: from delirium to dementia? J Clin Med. 2020;9(3):703.
DOI: 10.3390/jcm9030703
PMID: 32150970
26. Schneider C, Adamcova M, Jick SS, Schlagenhauf P, Miller MK, Rhein HG, et al. Antimalarial chemoprophylaxis and the risk of neuropsychiatric disorders. Travel Med Infect Dis. 2013;11(2):71-80.
DOI: 10.1016/j.tmaid.2013.02.008
PMID: 23541791
27. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2020;384(8):693-704.
DOI: 10.1056/NEJMoa2021436
PMID: 32678530
28. Brown ES, Khan DA, Nejtek VA. The psychiatric side effects of corticosteroids. Ann Allergy Asthma Immunol. 1999;83(6 Pt 1):495-503.
DOI: 10.1016/S1081-1206(10)62858-X
PMID: 10619339
29. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348(20):1986-94.
DOI: 10.1056/NEJMoa030685
PMID: 12682352
30. Cheng SK, Tsang JS, Ku KH, Wong CW, Ng YK. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: a series of 10 cases. Br J Psychiatry. 2004;184(4):359-60.
DOI: 10.1192/bjp.184.4.359
PMID: 15056583
31. Patten SB. Psychiatric side effects of interferon treatment. Curr Drug Saf. 2006;1(2):143-50.
DOI: 10.2174/157488606776930562
PMID: 18690925
32. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet. 2020;395(10228):e52.
DOI: 10.1016/S0140-6736(20)30558-4
PMID: 32171074
33. Cordes J, Lange-Asschenfeldt C, Hiemke C, Kahl KG. Psychopharmakotherapie bei Herz-Kreislauf-Erkrankungen. Internist (Berl). 2012;53(11):1304-13.
DOI: 10.1007/s00108-012-3070-1
PMID: 23052329
34. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47.
DOI: 10.1002/ajh.25829
PMID: 32282949
35. Orsini A, Corsi M, Santangelo A, Riva A, Peroni D, Foiadelli T, et al. Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients. Neurol Sci. 2020;41(9):2353-66.
DOI: 10.1007/s10072-020-04544-w
PMID: 32767055
36. [Leponex]. Povzetek glavnih značilnosti zdravila. Ljubljana: ZZZS; 2019 [cited 2020 Oct 21]. Available from: http://www.cbz.si/zzzs/pao/bazazdr2.nsf/o/BBBC8F54013AB7A7C12579C2003F57FC/$File/s-022625.pdf.
37. Interaction Checker. Liverpool: Liverpool Drug Interactions Group; 2019 [cited 2020 Oct 21]. Available from: https://www.covid19-druginteractions.org/.
38. Taylor D, Barnes TR, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th ed. London: Wiley-Blackwell; 2018. pp. 746-9.
39. English BA, Dortch M, Ereshefsky L, Jhee S. Clinically significant psychotropic drug-drug interactions in the primary care setting. Curr Psychiatry Rep. 2012;14(4):376-90.
DOI: 10.1007/s11920-012-0284-9
PMID: 22707017
40. Ayano G. Psychotropic medications metabolized by cytochromes P450 (CYP1A2) enzyme and relevant drug interactions: review of articles. Austin J Psychiatry Behav Sci. 2016;3(2):1054.
41. Taylor D, Barnes TR, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th ed. London: Wiley-Blackwell; 2018. pp. 112-8.
42. Beach SR, Celano CM, Noseworthy PA, Januzzi JL, Huffman JC. QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics. 2013;54(1):1-13.
DOI: 10.1016/j.psym.2012.11.001
PMID: 23295003
43. Taylor DM. Antipsychotics and QT prolongation. Acta Psychiatr Scand. 2003;107(2):85-95.
DOI: 10.1034/j.1600-0447.2003.02078.x
PMID: 12534433
44. Ozeki Y, Fujii K, Kurimoto N, Yamada N, Okawa M, Aoki T, et al. QTc prolongation and antipsychotic medications in a sample of 1017 patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(2):401-5.
DOI: 10.1016/j.pnpbp.2010.01.008
PMID: 20079791
45. Highlights of prescribing information. Berkshire: Abbvie; 2020 [cited 2020 Dec 28]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/021226s049lbl.pdf.
46. Kaletra 200 mg/50 mg film-coated tablets. Berkshire: Abbvie; 2020 [cited 2020 Dec 28]. Available from: https://www.medicines.org.uk/emc/product/221/smpc.
47. Kahl KG, Correll CU. Management of Patients With Severe Mental Illness During the Coronavirus Disease 2019 Pandemic. JAMA Psychiatry. 2020;77(9):977-8.
DOI: 10.1001/jamapsychiatry.2020.1701
PMID: 32579183
48. Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care. 2020;24(1):176.
DOI: 10.1186/s13054-020-02882-x
PMID: 32345343
49. Summary of Product Characteristics. Bruxelles: European Commission; 2020 [cited 2020 Oct 28]. Available from: https://www.ema.europa.eu/en/documents/other/veklury-product-information-approved-chmp-25-june-2020-pending-endorsement-european-commission_en.pdf.
Downloads
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
