Karim Sedky

Psychotropic Medications and Leukopenia

Neutropenia and/or agranulocytosis are among the medicinal side-effects induced by many psychotropic drugs. Clozapine and carbamazepine cause the highest incidence of this side-effect and require long-term blood cell monitoring. Bone marrow suppression can have an allergic, hypersensitivity etiology (e.g., clozapine), which mandates the causative drug discontinuation. It can also be a direct, toxic effect (e.g., carbamazepine), which calls for dosage reduction or a medication change. Other treatment options may include filgrastim, sargramostim, or lithium. Blood cell count monitoring is encouraged on patients receiving clozapine as long as the drug is continued. Such evaluation is also advised on those medicated with other psychotropics, especially carbamazepine.

Which psychotropic medications induce hepatotoxicity

OBJECTIVEnSafe prescribing practices to minimize pharmaceutically induced liver damage or worsening of preexisting conditions require knowledge about medicines with hepatotoxic potential. This paper reviews psychotropic medications and their effects on the liver.nnnMETHODSnA MEDLINE search was performed utilizing the phrase drug-induced liver injury with various categories of psychiatric drugs. Only articles written in English were utilized.nnnRESULTSnHepatotoxicity can be acute or chronic in nature. Medication discontinuation is necessary in acute forms, while close monitoring is required in milder forms of medication-induced chronic liver damage. Nefazodone, pemoline and/or tacrine are the highest offenders. Carbamazepine and valproate products (e.g., divalproex) can lead to this adverse event and should be avoided in patients with liver disease, persons with alcohol misuse or those consuming high doses of acetaminophen.nnnCONCLUSIONnKnowing the risk levels associated with various medicines is important; prescribing multiple drugs with hepatotoxic effects should be avoided. One should educate patients about early warning signs of liver injury. Always provide clinical and laboratory monitoring before and during the use of hepatotoxic drugs. Clinical features and laboratory results govern medication prescribing with ongoing risk-to-benefit ratio assessment during pharmacotherapy.

Long-Acting Antipsychotic Medications

Antipsychotic medicines are the cornerstone pharmacotherapy for patients with psychotic disorders. Early and continuous management of psychoses improves the quality of life, decreases hospitalization and reduces medical costs. However, many psychotic patients are not fully compliant with treatment, and thus they more often experience a relapsing course with a suboptimal clinical outcome. Long-term parenteral antipsychotic agents may improve compliance by offering clear evidence of medication non-compliance and documented drug administration monitoring. Using injection therapy might be especially beneficial to poorly compliant individuals with their first-psychotic episode and those with severe psychopathology or comorbid substance abuse. The availability of five different antipsychotic drug depot medications offers diverse treatment options which can be individualized for each case.

Attention deficit hyperactivity disorder and sleep disordered breathing in children

Children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) and/or sleep disordered breathing (SDB) may present with similar symptoms, including inattention, irritability, and hyperactivity. SDB is under-diagnosed in young people and is not often recognized in patients with ADHD; we hypothesize that treating sleep disordered breathing in ADHD patients may diminish symptoms and reduce ADHD-focused pharmacotherapy. A Medline search was performed using the criteria for ADHD and SDB. English language publications through January, 2012 were surveyed. Correlation between these two disorders is confounded due to methodological errors in research. The investigations lack consistency due to studies with small sample size, a dearth of diagnostic polysomnography (PSG) to detect SDB, varying definitions for the apnea/hypopnea index, and lack of uniform evaluations to diagnose ADHD. Despite methodological inconsistencies, the data suggests that treating SDB may have a productive impact on treatment outcomes in children with mild ADHD. Patients with ADHD symptomatology should receive SDB screening. In those with comorbid SDB and ADHD, an adenotonsillectomy (AT) may improve the prognosis. Treatment of SDB coexisting with ADHD aims to decrease clinical symptoms, reduce pharmacotherapy, and promote better health.

Acute Encephalopathies and Psychiatry

An encephalopathic delirium occurs due to a disturbance of brain function leading to a change in mental status. Fluctuating consciousness, hallucinations, disorientation, and short-term memory deficits are common presentations. This syndrome is more frequent among elderly people and occurs in up to 30% of hospitalized patients1. There are many medical conditions that can cause a delirium, including organ failures and electrolyte imbalances, etc. Polypharmacy and/or toxicities increase the risk of developing a confusional state. When considering a delirium diagnosis, a thorough evaluation is mandatory. This includes history taking from patients and their family, a physical examination, and a neurological evaluation. Laboratory investigations include a basic metabolic panel, a complete blood count, liver function tests, a calcium assay, toxicology or plasma drug level screening, thyroid stimulating hormone, urine analysis, and in certain cases, a rapid plasma reagin (RPR) and/or human immunodeficiency viral levels (HIV), etc. A computerized tomography scan of the head or magnetic resonance imaging is obtained in most cases. Early, prompt management of delirium decreases morbidity and mortality.