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[Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic].
Encephale. 2020 Jun; 46(3S):S14-S34.E

Abstract

The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.

Authors+Show Affiliations

Établissement Public de Santé Alsace Nord, Brumath, France; Laboratoire de toxicologie et pharmacologie neuro-cardiovasculaire, université de Strasbourg, Strasbourg, France. Electronic address: herve.javelot@ch-epsan.fr.CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France.Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, Rennes, France.Pôle universitaire de psychiatrie, CHU de Saint-Étienne, Saint-Étienne, France.Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, Laxou, France; Département de neurologie, CHU de Nancy, Nancy, France.Service de pharmacie, Établissement Public de Santé Alsace Nord, Brumath, France; Service de pharmacie, CHU de Strasbourg, Strasbourg, France.Service de pharmacie, CHS de Sevrey, Chalon-sur-Saône, France.Service de pharmacie, centre hospitalier de Cadillac, Cadillac, France.Département de pharmacie, CHU Henri-Mondor, Créteil, France; Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France.Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France; Service de psychiatrie sectorisée, hôpital Albert-Chenevier, Créteil, France.Nightingale Hospitals-Paris, clinique du Château de Garches, Garches, France; SHU, GHU psychiatrie et neurosciences, Paris, France.GHU psychiatrie et neurosciences, université de Paris, Paris, France; Sous-section 49-03, Conseil national des universités (CNU), Paris, France.Inserm U1127, service de psychiatrie adultes, ICM, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France.CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, Besançon, France; Laboratoire de neurosciences, université de Franche-Comté, Besançon, France.

Pub Type(s)

Journal Article
Review

Language

fre

PubMed ID

32376004

Citation

Javelot, H, et al. "[Informations On Psychotropics and Their Adaptations for Patients Suffering From Mental Disorders in France During the SARS-CoV-2 Epidemic]." L'Encephale, vol. 46, no. 3S, 2020, pp. S14-S34.
Javelot H, Llorca PM, Drapier D, et al. [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]. Encephale. 2020;46(3S):S14-S34.
Javelot, H., Llorca, P. M., Drapier, D., Fakra, E., Hingray, C., Meyer, G., Dizet, S., Egron, A., Straczek, C., Roser, M., Masson, M., Gaillard, R., Fossati, P., & Haffen, E. (2020). [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]. L'Encephale, 46(3S), S14-S34. https://doi.org/10.1016/j.encep.2020.04.006
Javelot H, et al. [Informations On Psychotropics and Their Adaptations for Patients Suffering From Mental Disorders in France During the SARS-CoV-2 Epidemic]. Encephale. 2020;46(3S):S14-S34. PubMed PMID: 32376004.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]. AU - Javelot,H, AU - Llorca,P-M, AU - Drapier,D, AU - Fakra,E, AU - Hingray,C, AU - Meyer,G, AU - Dizet,S, AU - Egron,A, AU - Straczek,C, AU - Roser,M, AU - Masson,M, AU - Gaillard,R, AU - Fossati,P, AU - Haffen,E, Y1 - 2020/05/04/ PY - 2020/04/14/received PY - 2020/04/17/accepted PY - 2020/5/8/pubmed PY - 2020/7/14/medline PY - 2020/5/8/entrez KW - COVID-19 KW - Drug interactions KW - Intéractions médicamenteuses KW - Psychotropes KW - Psychotropics SP - S14 EP - S34 JF - L'Encephale JO - Encephale VL - 46 IS - 3S N2 - The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency. SN - 0013-7006 UR - https://www.unboundmedicine.com/medline/citation/32376004/[Informations_on_psychotropics_and_their_adaptations_for_patients_suffering_from_mental_disorders_in_France_during_the_SARS_CoV_2_epidemic]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-7006(20)30074-9 DB - PRIME DP - Unbound Medicine ER -