Transient parotitis in the course of clozapine treatment: a case report and review of the literature

Introduction: Clozapine is an atypical antipsychotic, treatment of choice for patients unresponsive to, or intolerant of other antipsychotic drugs. While most of the adverse effects of clozapine are well discussed in the literature, clozapine-induced parotitis emerges as an uncommon complication, which clinicians should be aware of.Aim: The aim of this report is, by illustrating a case of clozapine-induced parotitis and reviewing the literature on the topic, to bring awareness of the occurrence of this potential adverse effect of clozapine treatment.Case Presentation: Due to poor response to several adequate trials with different antipsychotic medications a 57-year-old female with schizoaffective disorder was initiated on clozapine in 2008. The psychiatric condition of the patient notably improved in the following years. In 2016, after a decrease in her psychotropic therapy, the patient was hospitalized, and while restoring treatment with clozapine and divalproex she complained of increased salivation combined with painful bilateral parotid enlargement. The diagnosis of clozapine-induced parotitis was suggested. The medical condition had a favorable outcome within five days after administration of symptomatic medication.Conclusion: Adherence to drug treatment in psychiatric patients can be significantly improved if patients are well informed about the potential adverse effects of the administered medications and if the clinicians recognize and try to resolve them. Monitoring both common and rare adverse effects of clozapine treatment will give patients a chance of better therapy management

Evaluation of potential drug-drug interactions in psychiatric patients: a pilot study

Introduction: Drug-drug interactions (DDIs) are common but avoidable causes for adverse drug reactions.Aim: The present pilot study aimed to assess the prevalence of potential DDIs (pDDIs) among patients with psychiatric disorders by evaluation of patients` hospital records and their discharge medication lists.Materials and Methods: A retrospective review of medication information was conducted for 47 male patients consecutively admitted for a period of one month to the acute unit of a university-based psychiatric clinic. Potential DDIs were checked with Medscape drug interaction checker and standard references on drug interactions, and were classified as major, moderate, or minor according to their severity. The statistical analysis included: Chi-square test, Student`s t-test, and correlation analysis.Results: For the duration of the hospitalization a total of 121 interacting drug pairs were detected, potentially capable of inducing DDIs (2.57 per patient). Out of all the patients 44 (94 %) were exposed to at least one pDDI and 7 (15%) to at least one serious pDDI. The most common potential risk was the additive sedative effect, involving 58 drug pairs with an average rate of 1.23 per patient. QTc prolonging drug combinations were found in 11 (23%) patients, drug combinations with potential risk of hematologic toxicity in 10 (21%) patients and such with potential risk of hepatic/metabolic toxicity in 9 (19%). CYP-mediated pDDIs were identified in 8 (17%) patients. At hospital discharge fewer pDDIs per patient (1.13) were detected.Conclusion: A high prevalence of pDDIs among the psychiatric inpatients was recorded. Caution is warranted to limit the exposure of the patients to pDDIs

Quality of Life and Depressive Disorders in Epilepsy // Качество на живот и депресивни разстройства при епилепсия

[EN] Depressive disorders are the most frequent psychiatric comorbidity in epilepsy but very often remain unrecognized and untreated. We examined 106 patients with epilepsy (PWE), aged 18-60 years for the presence of interictal depressive disorder. All subjects underwent clinical psychiatric examination including evaluation on Hamilton Depression Rating Scale-17. A questionnaire for demographic and epilepsy-related variables was also completed. Patients completed two self-administered questionnaires: Seizure Severity Questionnaire to rate the severity of their seizures and Quality of Life in Epilepsy Inventory-31 (QOLIE-31) to evaluate the perceived quality of life (QOL). Comorbid depressive disorder was diagnosed according to ICD-10 criteria and ILAE classification for epilepsies and epileptic syndromes was used. Comorbid depression affected 30(28.3) of all evaluated patients. Employment and education out of the sociodemographic factors, seizure severity and seizure frequency out of the epilepsy-related ones and comorbid depressive disorder were associated with QOL scores. A three variable model accounted for 68,9 of the variance for QOLIE-31 overall score including seizure severity, comorbid depression and seizure frequency. Clinical factors were the strongest predictors of QOL of PWE in our study, seizure severity and comorbid depression being the leading ones. Comorbid depressive disorder was found to be a significant predictor for QOLIE-31 overall score as well as all subdomains except Seizure Worry and Medication Effects. The role of the sociodemographic factors in our database was weak. Recognition and treatment of comorbid depressive disorder was proved an important consideration in improving the QOL in epilepsy although a variety of assessment strategies may be needed to effectively portray the impact of the illness on the PWE.[BG] Целта ни бе да проучим основните фактори, влияещи върху качеството на живот (КЖ) на пациентите с епилепсия и мястото на коморбидните депресивни разстройства в комплексното му формиране, за оптимизиране на диагностично-терапевтичните и медико-социалните подходи в процесите на неговото подобряване. Изследвани бяха клинично 106 пациенти с епилепсия (анамнестични данни, психичен, соматичен и неврологичен статус). Приложени бяха и оценъчни скали: клинико-оценъчни, за обективизиране на тежестта на депресивното разстройство - Hamilton Depression Rating Scale-17 и самооценъчни, за оценка на КЖ при епилепсия - Quality of Life in Epilepsy Inventory-31 (QOLIE-31) и за оценка на тежестта на епилептичните пристъпи - Seizure Severity Questionnaire. Бе попълнена и анкетна карта за социодемографски показатели. Коморбидно депресивно разстройство бе установено при около 1/3 от пациентите(28.3), като преобладаваха леките и средно-тежки степени със значително снижена работоспособност и активност, психомоторна забавеност, повишена соматична и психична тревожност. Ролята на социодемографските фактори при формиране на КЖ на пациентите с епилепсия е относително слаба. Тежестта на епилептичните пристъпи оказва най-голямо модифициращо влияние върху измененията на общото КЖ при епилепсия, последвано от депресивното разстройство, честотата на пристъпите и трудовата заетост, като подреждането на първите три фактори се запазва и при изследването им в тяхното взаимодействие. Когато е налице депресивно разстройство, то оказва най-голямо модифициращо влияние върху измененията на общото КЖ, като тенденцията е най-изразена за скалите "емоционално благополучие", "когнитивно функциониране" и "енергия-умора". Ранното и точно диагностициране на коморбидното депресивно разстройство и неговото адекватно лечение са от съществено значение за подобряване на КЖ на пациентите с епилепсия. Клиничната оценка на КЖ при епилепсия дава определени възможности за неговото подобряване и би трябвало да заеме своето място в био-психо-социалния подход към заболяването